Multi-Modal Gait-Based Non-Invasive Therapy Platform

ABSTRACT

Apparatus and associated methods relate to a knee-position control system having a knee engagement pad, a lower-leg control member and an upper-leg control member, the knee engagement pad configured to naturally position a user&#39;s knee in response to movement of a foot-rest of a natural-gait therapy system. In an illustrative embodiment, the upper-leg control member may pivot about a point substantially axially coincident with a user&#39;s hip. In some embodiments, the upper-leg control member may be pivotally coupled to the lower-leg control member at a pivot point substantially axially coincident with a user&#39;s knee. The lower-leg control member may be pivotably coupled to the foot rest at a pivot point substantially axially coincident with a user&#39;s ankle. The knee-position control system may advantageously position a user&#39;s knee in a natural position relative to both the user&#39;s ankle and the user&#39;s hip, in response to movement of the user&#39;s foot.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application Ser.No. 61/915,834, titled “Natural-Gait Therapy Device,” filed by AlanTholkes et al., on Dec. 13, 2013. The entirety of the foregoingapplication is hereby incorporated by reference.

TECHNICAL FIELD

Various embodiments relate generally to therapy devices, and morespecifically to therapy devices for people with spinal cord injuries.

BACKGROUND

There are approximately twelve thousand spinal cord injuries (SCI) peryear in the United States alone. The average age of an injured person istwenty-eight years old. There are approximately three-hundred thousandpeople with SCIs in wheelchairs in the United States. In addition toSCIs, there are also many thousands of cases of strokes as well asthousands of cases of MS diagnoses each year in the United States.Furthermore, many other neurological problems afflict people and confinethem to wheelchairs. The numbers of such cases world-wide iscommensurately larger yet.

Providing such physically afflicted individuals an ability to stand mayhelp maintain and improve their health. Walking therapy may restorefunction in SCI individuals and in those who have suffered paralyzingstrokes. The beneficial results from walking therapy may be enhanced ifthe paralyzed individual can consistently and regularly perform thetherapy. Mental health benefits may accrue as well to SCI individualswho may independently exercise or practice therapy.

SUMMARY

Apparatus and associated methods relate to a knee-position controlsystem having a knee engagement pad, a lower-leg control member and anupper-leg control member, the knee engagement pad configured tonaturally position a user's knee in response to movement of a foot-restof a natural-gait therapy system. In an illustrative embodiment, theupper-leg control member may pivot about a point substantially axiallycoincident with a user's hip. In some embodiments, the upper-leg controlmember may be pivotally coupled to the lower-leg control member at apivot point substantially axially coincident with a user's knee. Thelower-leg control member may be pivotably coupled to the foot rest at apivot point substantially axially coincident with a user's ankle. Theknee-position control system may advantageously position a user's kneein a natural position relative to both the user's ankle and the user'ship, in response to movement of the user's foot.

Apparatus and associated methods may relate to a sit-to-stand therapydevice having a pivotable seat assembly coupled to a stationary framevia a U-shaped step-over beam, the pivotable seat assembly configured topivot between a sitting position and a standing position. In anillustrative embodiment, when a user is sitting on the seat pivoted tothe sitting position, the U-shaped step-over beam may travel from apivotable frame connection substantially collinear with the user's kneedown to a ground proximal elevation where it longitudinally traversestoward the seat, and then up to a seat connection. In some embodimentsthe sit-to-stand therapy device may have knee pads and foot restsconfigured to engage a user's knees and feet, respectively, when seated.In an exemplary embodiment, a dynamically adjustable seat back maymaintain vertical engagement with a user's back throughout a transitionfrom the sitting position to the standing position.

Apparatus and associated methods may relate to a knee-position controlsystem having a knee engagement pad, a lower-leg control member and anupper-leg control member, the knee engagement pad configured tonaturally position a user's knee in response to movement of a foot-restof a natural-gait therapy. In an illustrative embodiment, the upper-legcontrol member may be pivotally connected to a pivot point substantiallyaxially coincident with a user's hip. In some embodiments, the upper-legcontrol member may be pivotally coupled to the lower-leg control memberat a pivot point substantially axially coincident with a user's knee.The lower-leg control member may be coupled to the foot rest at a pivotpoint substantially axially coincident with a user's ankle, for example.The knee-position control system may advantageously position a user'sknee in a natural position relative to both the user's ankle and theuser's hip, in response to movement of the user's foot.

Apparatus and associated methods may relate to a natural-gait therapydevice for enabling a user with a Spinal Cord Injury (SCI) toindependently transfer to the device, lift a user's body to a standingposition and hand-power a natural-gait motion of the user, the devicehaving a transfer mode, a standing mode, and a natural-gait mode,wherein, when in the transfer mode, a seat and foot rests are configuredin substantially similar positions as a standard wheelchair'scorresponding seat and foot rests to facilitate a lateral transfer ofthe user from an adjacent wheelchair to the device, wherein, when theuser actuates a lifting module, the seat lifts and rotates to a standingposition, and when the user actuates a gait module, the user's body islocomoted in a natural-gait. In an exemplary embodiment, thenatural-gait therapy device may advantageously provide positive healthbenefits to individuals with SCIs.

Apparatus and associated methods may relate to a natural-gait therapydevice for enabling a user with a Spinal Cord Injury (SCI) toindependently transfer to and from the device by providing one or morebase support members within a footprint of the seat, wherein the basesupport members are configured to receive the front wheels of awheelchair that is positioned adjacent to a seat of the therapy system,the wheelchair being rotated an acute angle with respect to a seat ofthe therapy system so that the front wheels project in front of aportion of the seat of the therapy system. In some embodiments, a seatsupport member may be within the footprint of the seat as well. In anexemplary embodiment, the natural-gait therapy device may advantageouslyfacilitate transfers to and from the device for individuals with SCIs.

Apparatus and associated methods may relate to a natural-gait therapydevice for enabling a user with a Spinal Cord Injury (SCI) toindependently power a lifting of the user's body from a transferposition to a secure standing position, the natural-gait therapy devicehaving a seat support member having a transfer position and a standingposition wherein, when in the transfer position, the seat support memberextends from a cage in front of the user to the seat via a step-overextension member, wherein the step-over extension member is disposedbetween an elevation below a top of the footrests to avoid encumberingthe translation of the user's feet between footrests and the user's footposition prior to entry or upon exit of the system. In some embodiments,the seat support member may pivot a seat about a pivot pointsubstantially collinear with the pivot points of a user's knees.

Apparatus and associated methods may relate to a natural-gait therapydevice for enabling a user with a Spinal Cord Injury (SCI) toindependently power a lifting of the user's body from a transferposition to a standing position, the natural-gait therapy device havinga seat-back attitude control mechanism that maintains the seat-back in asubstantially vertical attitude throughout a travel from a transferposition to a standing position. In some examples, a back-support may bepivotably coupled to a seat, wherein a seat-back attitude controlmechanism maintains the seat-back in a substantially verticalorientation as the seat is raised and rotated during the liftingoperation. In some examples, a torso stabilization member may providefront stabilization of a user's torso. The seat, seat-back and torsostabilization member may advantageously provide multiple-point standingsupport for a user who may have limited control of a lower body.

Apparatus and associated methods may relate to a natural-gait therapydevice for enabling a user with a Spinal Cord Injury (SCI) toindependently transition between a locked standing position and a usercontrolled coordinated natural-gait movement, the method including anunlocking of a left and a right foot movement members, rotating one ofthe unlocked left and right movement members to a half-period gaitposition that is 180 degrees out of phase with the un-rotated one of theleft and right movement members, coupling the left and right movementmembers in the 180 degree phase differential orientation, and rotatingboth left and right leg movement members in a natural-gait motion. Insome embodiments, the left and right movement members may be uncoupledto permit a gravity assisted return to a standing position. Thetransition between the standing and the natural-gait motion mayfacilitate a user to stand before or sit after performing natural-gaittherapy.

Various embodiments may achieve one or more advantages. For example,some embodiments may provide a natural-gait therapy device having seatinto which a user may easily transfer to and from. Some embodiments mayenable a user to stand independently using a hand powered operation.Some embodiments may facilitate a user to independently locomote theuser's body in a natural-gait. In an exemplary embodiment, a biostimulation of locomotion muscles may be cyclically coordinated with thenatural-gait motion, for example, as a function of the angular positionwithin a gait-cycle. The bio-stimulation may include periodic electricalstimulation signals that are generated and applied to the user.

In an exemplary embodiment, a user may independently performnatural-gait therapy, without requiring assistance of another person.Such independence may promote a higher frequency of therapy for theuser. In some embodiments, the cost of therapy may be reduced. Reducingtherapy costs may again promote the frequency of therapy. Independentuse and/or reduced costs may result in better health of the user. Insome embodiments, natural-gait therapy may provide for a recovery ofsome body function for the user. Users may also enjoy satisfaction ofnatural-gait movements. Such satisfaction may promote the psychologicalwell-being of users. In various examples, some embodiments may have afootprint and form factor that readily permits installation in a typicalresidential home.

The details of various embodiments are set forth in the accompanyingdrawings and the description below. Other features and advantages willbe apparent from the description and drawings, and from the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A-1D depicts a sequence of vignettes depicting different stagesof use of an exemplary natural-gait therapy device.

FIGS. 2A-2E depict an exemplary natural-gait-therapy device at variousstages of lifting a user from a transfer position to a standingposition.

FIG. 3 depicts an exploded view of a torso stabilization member.

FIGS. 4A-4D depict an exemplary leg crank for a natural-gait therapydevice.

FIGS. 5A-5H depict an exemplary natural-gait therapy device depicting asequence of phases of the natural-gait locomotion.

FIG. 6 depicts a close-up view of an exemplary wheel of an exemplaryrolling foot-drive member.

FIG. 7 depicts a close-up view of an exemplary knee engagement member.

FIGS. 8A-8B depict a close-up view of a heel lift system.

FIGS. 9A-9B depict an exemplary transmission module for an exemplarynatural-gait therapy device.

FIG. 10 depicts a perspective view of an exemplary natural-gait therapydevice.

FIG. 11 depicts a perspective view of an exemplary natural-gait therapydevice having independent upper and lower chain tensioning mechanisms.

FIGS. 12A-12D depict an exemplary sit-to-lift therapy device.

FIGS. 13A-13B depicts a perspective view of an exemplary natural-gaittherapy system.

FIGS. 14A-14D depict an exemplary natural-gait therapy system without aprotective covering and without a pivotable seat assembly.

FIG. 15 depicts an exemplary embodiment of a knee position controlsystem with hyperextension protection.

FIGS. 16A-16B depict an exemplary stand-to-walk transmission system.

FIGS. 17A-18B depict an exemplary zero-degree safety system.

FIGS. 18A-18B depict an exemplary zero-degree safety system.

FIGS. 19A-19C depict an exemplary automated treadmill therapy system.

FIGS. 20A-D depict an exemplary lift system for use with a natural-gaittherapy system.

FIGS. 21A-B depict an exemplary multi-modal therapy platform controlsystem.

FIGS. 22A-B depict close-up views of an exemplary spinal therapy system.

FIG. 23 depicts a flow chart of an exemplary method of providingcoordinated muscle stimulation in response to a natural-gait position ofa user's body.

FIGS. 24A-B depict an exemplary foot rest for coordinated operation witha tread mill.

FIG. 25 depicts a closeup perspective view of exemplary FES stimulationand bio-feedback cuffs.

FIG. 26 depicts an exemplary natural-gait therapy system that isautomated. Like reference symbols in the various drawings indicate likeelements.

DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS

To aid understanding, this document is organized as follows. First, anexemplary natural-gait therapy device is briefly introduced withreference to FIGS. 1A-1D. These figures will aid a discussion about thevarious steps of use through which a user may sequence. Second, withreference to FIGS. 2A-3 the discussion turns to exemplary embodimentsthat illustrate some of the features of an exemplary natural-gaittherapy device associated with a transfer operation. This discussionwill highlight novel aspects an exemplary implementation thatfacilitates a transfer to and from a wheelchair. This discussion willalso describe some of features that provide a body to be secure in thestanding position. Then, with reference to FIGS. 4A-4D, a foottransition from a side-by-side standing position to an oppositional footposition used in a natural-gait will be described. This will be followedby a discussion of locomotion of a natural-gait therapy, with referenceto FIGS. 5A-8. Then, with reference to FIGS. 9A-9B, an exemplarytransmission module will be described. The exemplary transmission modulemay provide the modality of a locked transfer/standing leg position, anoppositional synchronization of feet during a natural-gait mode, as wellas a transition between modes.

The sit-to-stand operation will be then revisited and described, withreference to FIGS. 12A-12B. To protect user's from moving parts,exemplary natural-gait therapy devices may have protective coverings.With reference to FIGS. 13A-13B, two exemplary natural gait therapydevices are depicted, each with a different style of protectivecovering. Then with reference to FIGS. 14A-14D, an exemplarynatural-gait locomotion system is described. Each of four subsystemsthat coordinate a natural-gait locomotion will be discussed: atoe-position control system, a forefoot-angle control system,knee-position control system, and a heel-lift control system. Thendiscussion will focus on the exemplary knee-position control system andits hyperextension protection subsystem, with reference to FIG. 15.Before a user performs natural-gait therapy, the user's feet may betransitioned from a side-by-side position to an out-of-phase walkingposition. An exemplary stand-to-walk transition module will bedescribed, with reference to FIGS. 16A-16B. After performingnatural-gait therapy and before returning to a sitting position, theuser's feet should be returned to a side-by-side position.

A safe-sitting interlock system will be described, with reference toFIGS. 17A-18B, in which a user's the therapy device returns the footrests to a side-by-side position before lowering a seat bottom to asitting position. Then, with reference to FIGS. 19-23 and 25-26,exemplary multi-modal functions (e.g. coordinated muscle stimulation,nerve therapy, etc.) will be described. Finally, Discussion will followwith a description of an exemplary foot rest with coordinated operationwith a treadmill, with reference to FIGS. 24A-B.

An exemplary natural-gait therapy device may assist a user toindependently perform natural-gait therapy by facilitating one or moreof the following seven steps. A first step often may includetransferring from a wheelchair to the seat of a natural-gait therapydevice. A second step may include lifting the user from a transferposition to a standing position. A third step may include transitioningfrom a side-by-side foot standing position to an opposition-orientedfoot natural-gait position. A fourth step may include locomoting thebody to perform a natural-gait motion. A fifth step may includetransitioning from the opposition-oriented foot natural-gait position tothe side-by-side foot standing position. A sixth step may includedescending from a standing position to a transfer position. A seventhstep may include transferring from the natural-gait therapy device backinto the wheelchair.

FIGS. 1A-1D depicts a sequence of vignettes depicting different stagesof use of an exemplary natural-gait therapy device. In FIG. 1A, a user100 is transferring from a wheelchair 105 to an exemplary natural-gaittherapy device 110. In FIG. 1B, the user 100 is lifting the body from atransfer position to a standing position. In FIG. 1C, the user 100 istransitioning the leg position from a side-by-side standing feetposition to an opposition-located natural-gait feet position. And inFIG. 1D, the user 100 is using the user's arms to power the user's bodythrough repeating natural-gait cycles. The user 100 may “unwind” thisprocess when finished with a therapy session, by going through the abovesteps in a reverse order to return to the wheelchair 105.

A therapy session may begin by transferring from the wheelchair 105 to anatural-gait therapy device 110. Transferring methods may vary dependingon many factors such as: the size and/or design of the wheelchair; thelevel of function that the transferring person has (for example,strength in upper limbs); whether the transfer is independent orassisted; and personal preferences. In FIG. 2A, an exemplarynatural-gait therapy device 200 is depicted in a transfer mode. In thetransfer mode, a seat 205 of the natural-gait therapy device 200 may isdepicted in a transfer position. In the transfer position, an armrest210 may be pivoted back so that the armrest 210 is not interposedbetween the wheelchair 105 and the seat 205 of the natural-gait therapydevice 200. In the transfer mode, footrests 215 may be locked into aside-by-side foot position. The wheelchair 105 may be positionedadjacent to the seat 205 of the natural-gait therapy device 200. Thewheelchair 105 may be maneuvered until it is approximately parallel withthe adjacent seat 205, with the front of the wheelchair's seat alignedwith the front of the seat 205 of the natural-gait therapy device 200.Alternatively, the transfer may be angled, with the wheelchair at anacute angle with respect to the adjacent seat. The transferee may pushfootrests of the wheelchair 105 out of the way during a transferoperation.

If the user should have enough upper body strength, the user may supportthe user's body using the user's arms. In some instances, the user maysupport the body using one or more of the following supports: i) theseat of the natural-gait therapy device; ii) the seat of the wheelchair;iii) an arm support of the natural-gait therapy device; iv) an armsupport of the wheelchair; v) an auxiliary support member; and/or vi)assistance from another person or persons. The user may support theuser's upper body sufficiently to at least permit the body to slide overany intervening obstacles between the wheelchair's seat and the seat 205of the natural-gait therapy device 200. One such intervening object maybe a side-rail of the wheelchair and/or the wheelchair's wheel.

In some embodiments, the user may use a rope or handle suspended fromabove to assist in the transfer process. In various embodiments, varioustransfer auxiliary support members may be used. In some embodiments,such transfer assist members may be movable from an assisting positionto a stowing position. For example, a suspended assisting handle may bemovable so as to provide suspended support above the seat 205 of thenatural-gait therapy device 200. The suspended assisting handle may thenbe moved so that it may no longer remain above the seat 205 after theuser transfers to the natural-gait therapy device 200. In someembodiments, a folding mechanism may facilitate movement fromtransferring position to a stowing position. In an exemplary embodimenta pivot may be used to facilitate movement between a transfer mode to astowage mode.

A difference between a seat height of the seat 205 of the natural-gaittherapy device 200 and the seat of a wheelchair may be small. A largedifference in seat height may make transfer to or from the natural-gaittherapy device 200 difficult. Many adult sized-wheelchairs may have aseat height of approximately twenty inches above ground level. In someembodiments, a difference between a seat height of the seat 205 of thenatural-gait therapy device 200 and a wheelchair's seat may be less thanthree inches. In some embodiments, the difference may be less than twoinches. In some embodiments, the difference may be less than one and ahalf inches inch. In some embodiments, the seat height of the seat 205of the natural-gait therapy device 200 may be substantially equal to theseat height of a standard wheelchair's seat. In various embodiments, theseat 205 of the natural-gait therapy device 200 may have a heightadjustment member for adjusting the seat's height. For example, in someembodiments, a seat support member may have a series of adjustmentholes, and a seat post may be inserted into the seat support member andsecured using one of the adjustment holes. In some embodiments, apneumatic piston may provide height adjustment. In some embodiments, ascrew member may provide height adjustment.

After transferring the user's body from the wheelchair 105 to the seat205 of the natural-gait therapy device 200, the user may transfer theuser's legs to the foot rests 215 of the natural-gait therapy device200. To facilitate the transfer of the user's legs to the leg rests 215,a height of the foot rests may be near to the ground when in thetransfer position. In some embodiments, the foot rests may be within sixinches of ground level when in the transfer position. In variousembodiments, the foot rests may be within 5 inches, 4 inches, 3.5inches, 2 inches, or even closer to ground level when in the transferposition. In the depicted embodiment, the foot rests 215 are depictedhaving a height adjustment member 220. The height adjustment member 220may provide series of apertures, through which a pin may secure the footrest 215 to a foot motion platform 225.

Various body securement devices may secure the body, now transferred, tothe natural-gait therapy device 200. For example, foot straps may securethe transferred feet into the foot rests 215. Such foot straps may usehook and loop fasteners, for example. In some examples, buckles may beused for securing the user's foot to the foot rest 215. In someembodiments, laces may be used to secure feet to the foot rests 215. Thefoot rests 215 may have a coating for promoting friction between theuser's feet and the foot rests. In one exemplary embodiment, the footrest 215 may include a boot for securing the feet of a user. A seat beltmay secure a user to the seat 205 of the natural-gait therapy device200, for example. The arm rests 210 may provide lateral security to thebody of a user when the armrests 210 are pivoted to a closed position oneither side of the user. A user's knees may be secured in a knee rests230 by a knee strap. In some embodiments, the knee strap may cross theback of the user's knee and secure the knee to the knee pad 230. Variousmethods of securing a user's knees to the knee pads may be used. In someembodiments, a hook and loop type of system may be used to secure theknee. In some embodiments, a strap and buckle may be used. Securing theknee to the knee pad 230 may couple the knee movement to the movement ofa knee joint 235 of the natural-gait therapy device 200. This couplingmay ensure that knee flexion of the user is performed in an anatomicfashion. Even if a user has no control of the leg, the knee may beprevented from movements in dangerous non-anatomic ways.

FIGS. 2A-2E depict an exemplary natural-gait-therapy device at variousstages of lifting a user from a transfer position to a standingposition. In FIG. 2A, the exemplary natural-gait therapy device 200 isdepicted in a transfer position. In FIG. 2B, the exemplarynatural-gait-therapy device 200 is depicted after the user may havelifted the seat 205 to a partially raised position, perhaps on the wayto a full standing position. In FIG. 2C, the exemplary natural-gaittherapy device 200 is depicted after the user may have lifted the seat205 further toward the full standing position. In FIG. 2D, the exemplarynatural-gait therapy device 200 is depicted after the user may havelifted the seat 205 to a full standing position. And in FIG. 2E, thenatural-gait therapy device 200 is shown with selective members madetransparent so as to better depict an exemplary seat-back attitudesystem 285.

In an exemplary embodiment, the lifting of the seat 205 and the user'sbody seated in the seat may be performed using various liftingmechanisms. In the FIGS. 2A-2E depictions, a hydraulic pump 240 may beused to lift the seat 205 and the user's body. In the depictedembodiment, a lifting handle 245 is coupled to the hydraulic pump 240.The lifting handle 245 may be positioned within the reach of the userthroughout the lifting process, so that a user who has hand strength mayindependently lift the user's body from the transfer position to thestanding position. In some embodiments, the lifting handle 245 may belong so as to provide mechanical leverage to facilitate the ease oflifting the seat 205 and user's body. Various means for lifting a seat205 from a sitting position to a standing position may be employed. Forexample, an electric motor may be used to lift the seat 205 and theuser's body. In an exemplary embodiment, a mechanical screw thread maybe used to lift the user to a standing position. Some examples may usean electric hydraulic pump as a lifting means. In one example, and gasspring may be used as a means for lifting the seat 205 and user's bodyfrom a transfer position to a standing position.

In the depicted embodiment, a U-support member 250 couples the seat to acage 255 of the natural-gait therapy device. The U-support member 250may be pivotably coupled to the cage 255. The U-support member 250 mayhave a substantially linear foot-crossing section 260 that, when in thetransfer position, is substantially parallel to the ground and at a lowelevation above the ground. When in the transfer position, as depictedin FIG. 2A, the foot-crossing section may have a top surface 265 thathas an elevation less than four inches above a foot-bearing surface ofthe foot rests 215. This low elevation may advantageously facilitate auser's transfer of the user's foot across the foot-crossing section 260during the transfer operation. In some embodiments, the elevation of thetop surface 265 of the foot-crossing section 260 may be less than 2.5inches above the foot-bearing surface of the foot rests 215. In anexemplary embodiment, the elevation of the top-surface 265 of thefoot-crossing member 260 may be substantially equal to the elevation ofthe foot-bearing surface. In some embodiments, the elevation of the topsurface 265 of the foot-crossing section 260 may be less than or equalto a top of a side-wall 270 of the foot rests 215.

In some embodiments, a pivot location of a pivotable coupling of theU-support member 250 to the cage 255 may be substantially in-line withknee pivot joints 235 of leg members of the natural-gait therapy device200. The locations of these pivot locations being substantially in-linewith each other may advantageously provide for pivoting of the body fromthe transfer position to the standing position in a manner that isconsistent with the anatomical motion of the body pivoting about theknees. Pivoting about the knees may minimize the sheer force on the seatbottom of the user as the user pivots from a transfer position to astanding position. The adjustable foot-rest height may further promotethese advantages by providing a means for coordinating the pivotlocation of a user's knees with the pivot location of the knee pivotjoints 235 of a natural-gait therapy device 200.

In some embodiments, the seat 205 may be laterally adjustable. Forexample, a lateral adjustment mechanism may provide an adjustableforward/backward seat position. To accommodate a shorter user, forexample, the foot rests 215 may be adjusted to a high position to ensurethat the user's knees may be substantially coordinated with the kneepivot joints 235 of the natural-gait therapy device 200. The lateralseat position may be adjusted forward so that the arc traced by theforward portion of the seat during the lifting operation is smaller fora shorter person than for a taller person. Such lateral adjustabilitymay provide better correlation between the anatomical movement of theuser and that of the seat 205 of the natural-gait therapy device 200during the lifting operation.

During the lifting operation as depicted in FIGS. 2A-2E, a seat-back 275of the natural-gait therapy device 200 rotates relative to theseat-bottom 280 during the lifting operation. A seat-back attitudesystem 285 may provide this function. The depicted seat-back attitudesystem 285 includes a mechanical linkage system that provides forcontinuous attitude adjustment throughout the entire lifting operation.The seat-back 275 is pivotably coupled to the seat-bottom 280 at a pivotjoint 290. An upper attitude control member 295 is pivotably coupled tothe seat-back 275 at a pivot joint 297. The upper attitude controlmember 295 may rotate the seat-back 275 about the pivot joint 297. Theseat-back 275 may be rigidly maintained in a substantially verticalattitude throughout the lifting operation.

When the upper attitude control member 295 is raised, the seat-back 275may rotate forward about the pivot point 297. And when the upperattitude control member 295 is lowered, the seat-back 275 may rotatebackward about the pivot point 297. The upper attitude control member295 may be raised and lowered in response to the lifting of theU-support member 250. A lower attitude control arm 287 and an attitudecontrol lever 289 may assist this operation. When the U-support member250 is rotated from a transfer position toward a standing position, adistance between two pivot points 292, 294 increases. In response tothat increase separation between the pivot points 292, 294, the attitudecontrol lever 289 may rotate clockwise and lower the upper attitudecontrol member 295 with respect to the U-support member 250. Thislowering of the upper attitude control member 295 rotates the seat-back275 open with respect to the seat-bottom 280. Both the upper attitudecontrol member 295 and the lower attitude control member 287 arepivotably coupled to the attitude control lever 289 so as to perform theattitude control operation.

Various means of providing for a proper seat-back attitude during thelifting operation may be used. In some embodiments, a cable mechanismmay provide for proper seat-back attitude during the lifting operation.In some embodiments, a cable distance may change in response to arotation of a transfer/standing support member movement. In the depictedembodiment, the mechanical linkage is located substantially within theU-support member 250. Locating the mechanical linkage for the seat-backattitude system 285 within the U-support member 250 may minimize theinterrupted space between a user's legs when the U-support member 250 isin the standing position.

The user may be safely secured in the standing position using one ormore securing means. The user's feet may be secured into the foot rests215 using a foot securing means. The user's knees may be secured intothe knee pads 230 using a knee securing means. The user may be securedinto the seat 205 using a seat securing means. FIG. 3 depicts anexploded view of a torso stabilization member. In the FIG. 3 embodiment,a torso stabilization member 300 may include a forward/backwardadjustment member 305. The torso stabilization member 300 may beadjustable to provide frontal support for individual users of differentsizes. The depicted forward/backward adjustment member 305 may include aspring-loaded securing pin 310 and a pin-release lever 315. Thespring-loaded securing pin 310 may project into one of a plurality oflocating holes in a bottom side of the torso stabilization member 300.The pin-release lever 315 may be pulled in a downward direction by auser to release the spring-loaded securing pin 310. The pin-releaselever 315 may travel in a slot 320 to provide the throw needed to bringthe spring-loaded securing pin 310 free of the one of the plurality oflocating hole in which it may reside.

In some embodiments, a vertical adjustment member may be used tofacilitate a vertical position of the torso stabilization member 300. Inthe depicted embodiment, a plurality of locating holes 325 is shown on avertical support torso support member 330. Each of the plurality oflocating holes 325 may be captured by a securing pin similar to thespring-loaded securing pin 310 of the forward/backward adjustment member305. Various means for adjusting a torso stabilization member 300 may beimplemented. For example, a removable pin may be inserted into anadjustment aperture to capture one of a plurality of selectable positionapertures in a complementary member. In some embodiments, a screw threadcontrolled adjustment means may be used.

In some embodiments, the torso stabilization member 300 may be concaveas depicted in the FIG. 3 embodiment. This concave shape of the torsostabilization member 300 may provide some lateral stability to the user.In some embodiments, one or more lateral torso members may extend fromthe torso stabilization member 300 toward the seat-back 275. In someembodiments, securing straps may connect the torso stabilization member300 to the seat-bottom 280 and/or seat-back 275 to provide lateralsecurity for the user. Such securing straps may be fixed to theseat-back 275, for example. A free end of the securing strap may bereleasably attached to the torso stabilization member 300, or to a strapconnected to the torso stabilization member 300, for example. In anexemplary embodiment, a securing strap may releasably couple the torsostabilization member 300 to the armrests 210 of the seat 205. Lateraltorso members may provide secure stability to users who have littlecontrol for maintaining a vertical body position.

FIGS. 4A-4D depict an exemplary leg crank for a natural-gait therapydevice. In the FIGS. 4A-4B depiction, an exemplary leg crank 400 isdepicted in a side-by-side/standing mode. In the FIGS. 4C-4D depictions,and exemplary leg crank 400 is depicted in an opposition/natural-gaitmode. The leg crank 400 is actually two independent leg cranks, a rightleg crank 405 and a left leg crank 410. When in the transfer mode, andwhen in a standing position, the right and left leg cranks 405, 410 arealigned as depicted in the transfer/standing mode figures (FIGS. 4A-4B).In FIG. 4A, the right and left leg cranks 405, 410 appear to share asingle axel 415, but in FIG. 4B, the exploded view reveals that in thisembodiment the left leg crank 410 has a left axel 420 having and opencenter with an inner diameter. The figure depicts the right leg crank405 having a right axel 425 with an outer diameter. In the depictedembodiment, the outer diameter of the right axel 425 is smaller than theinner diameter of the left axel 420. Independent right and left axels420, 425 may permit the crank positions to be transitioned from theside-by-side/standing mode to the opposition/natural-gait mode. In thedepicted embodiment, the rotational orientation of each of the legcranks 405, 410 is determined by a right and a left chain eachcorresponding to a right and a left chain gear 430, 435. Each of theright and the left chain gears 430, 435 is rigidly coupled to thecorresponding right or left axel 425, 420. Each of the right or leftaxels 425, 420 is rigidly coupled to a right or left drive arm 440, 445.

The independent control of the leg cranks 405, 410 may advantageouslypermit the transition from a side-by-side/standing position of the footrests 215 to an opposition/natural-gait position of the foot rests 215.When a body is performing a natural-gait motion, each of the user's feetmay be in opposition and may travel in an elliptical path. Over a cycleof a natural-gait, the two feet may be in opposition and/or may have a180 degree phase differential. Thus, during a natural-gait cycle, thetwo feet may not be side-by-side as they typically are in the standingposition. Even when the two feet have approximately the same position asmeasured in the forward/backward direction, one of the two feet may havea higher elevation than the other. Transitioning from theside-by-side/standing position to the opposition/natural-gait positionmay be done before the natural-gait cycling of the legs may begin.

To accomplish this transition from the side-by-side/standing position tothe opposition/natural-gait position, only one of the leg cranks 405,410 may be rotated, and the other leg crank 410, 405 may remain in afixed position. The rotated leg crank 405, 410 may be rotated half acycle, until the rotated leg crank 405, 410 is approximately 180 degreesout of phase with the fixed leg crank 410, 405. Then the right and leftleg cranks 405, 410 may be coupled together in the above described 180degree phase differential or opposition. When the two leg cranks 405,410 are coupled in opposition, the leg cranks 405, 410 may rotatetogether with the same frequency, but always remaining 180 degrees outof phase with respect to each other.

FIGS. 5A-5H depict an exemplary natural-gait therapy device depicting asequence of phases of the natural-gait locomotion. Each of the FIGS.5A-5H show an exemplary natural-gait therapy device 500, each with feetpositions at different phases in a natural-gait cycle. For example, ifthe feet position of the FIG. 5A depiction is called the zero degreeposition, then FIGS. 5B-5H correspond to the 45, 90, 135, 180, 225, 270,and 315 degree positions, respectively. Locomotion of a natural-gait maybe induced by a locomotion module. In the depicted embodiment a handpowertrain 505 provide locomotive power to the natural-gait therapydevice. In the depictions, a hand powertrain 505 does not reflect thephase orientations that should be associated with the various phasepositions of the foot rests.

When the natural-gait therapy device 500 is operating in a natural-gaitmode, each of the left and right drive arms 445, 440 may be pivotablycoupled to a left and right rolling foot-drive member 510, 515,respectively. FIG. 6 depicts a close-up view of an exemplary wheel of anexemplary rolling foot-drive member 510, 515. Each of the depictedrolling foot-drive members 510, 515 has a wheel 600 that rides in adrive track 605. The wheel 600 may be attached to a distal end 610 ofthe rolling foot-drive member 510, 515. In the depicted embodiment, aprotruding axel guide 620 may extend from either side of an axel of thewheel 600. This protruding axel guide 620 may be captured by one or moreflanges 625 of the drive track 605. The flanges 625 of the drive track605 may retain the rolling foot-drive member 510, 515 within the drivetrack 605. The retention of the rolling foot-drive member 510, 515within the drive track 605 may prevent the rolling foot-drive member510, 515 from being accidentally removed from the drive track 605.Various users may present various forces upon the contact points with anexemplary natural-gait therapy device. Different types of user's bodiesand different user's abilities may provide for a broad distribution offorce profiles. For example, when transitioning from a sitting positionto a standing position, some users may exert a force on the knee padsthat may otherwise result in the rolling foot-drive member 510, 515 torise up and out of the drive track 605.

A proximal end 520 of the rolling foot-drive member 510, 515 may bepivotably coupled to the left or right drive arm. The proximal end maytravel in a circular orbit determined by the rotating drive arm 440, 445to which the rolling foot-drive member 510, 515 may be pivotablycoupled. The distal end 610 may travel in a back-and-forth linear motionalong the drive track 605. A foot-drive connecting point 525 somewherebetween the distal end 610 and the proximal end may pivotably couple therolling foot-drive member 510, 515 to the foot motion platform 225. Themotion of this foot-drive connecting point 525 is determined by theinterpolated motion of the back-and-forth linear motion and the circularmotion of the extreme ends (distal and proximal ends). This motion maybe called elliptical motion and has a forward and backward component aswell as an up and down component.

Not only will the foot motion platform be moved in an elliptical fashionat the foot-drive connecting point 525, but a rotation of the angle ofthe foot rest 215 with respect to the ground may also be achieved. Inthe depicted embodiment, the rotation of the foot rest 215 may have acyclic behavior having the same cycle frequency as the ellipticalmotion. This may result from a linkage creating the foot rotation, thelinkage being driven by the elliptical movement. In the depictedembodiment, a foot extension member 530 extends from the foot motionplatform 225 forward and past the pivotable connection point of the footmotion platform 225 and the rolling foot-drive member 510, 515. At thedistal end of foot extension member 530 as measured from the foot motionplatform 225, the foot extension member 530 pivotably couples to apendulum support member 535. The other end of the pendulum supportmember 535 is attached to the cage 255 at a pivot location. The amountof foot rotation may be determined by a ratio of the lengths of the footextension member 530, from the pivot location of the foot motionplatform 225 to the pivot location at the pendulum support member 535,to the length of the pendulum support member between its two pivotpoints. In some embodiments, one or both of these members may beadjustable so as to control the amount of foot rotation.

The knee movement is coupled to the cyclic motion of the foot motionplatforms 225. In the depicted embodiment, a lower leg member 540 ispivotably coupled to the foot motion platform 225 at a foot connectingend of the lower leg member 540. The lower leg member 540 is pivotablycoupled to an upper leg member 545 at a knee end of both the lower andupper leg members 540, 545, respectively. The upper leg member 545 ispivotably coupled to the cage 255 at a hip connecting end of the upperleg member 545. The lower and upper leg members 540, 545 move inresponse to the foot motion platforms 225 which are driven by therolling foot-drive members 510, 515. The pivot locations connecting theknee ends of the upper leg members 545 to the knee ends of the lower legmembers 540 may facilitate a natural-gait leg motion during natural-gaitoperation.

FIG. 7 depicts a close-up view of an exemplary knee engagement member.In the FIG. 7 embodiment, a knee engagement member 700 may couple to theknee end of the lower leg member 540. A knee pad 230 may be slidablycoupled to the knee securing member 550 providing a vertical slide pathfor the knee pad 230. A slidable knee coupling member 705 may protectagainst chafing of the knee during the cyclic movement of thenatural-gait movement. For persons whose leg dimensions mismatch thecorresponding dimensions of the natural-gait therapy device 500, theslidable knee coupling member 705 may minimize sheer forces to theuser's knee against the knee pad 230. In some embodiments, thenatural-gait motion of a user's legs may exercise the slidable kneecoupling member 705 to prevent chafing the user's knees.

In some embodiments, the knee engagement member 700 and the knee pad 230are configured to locate a pivot joint of the user's knees to be in linewith the pivot joint of the pivotable connection between the lower legmember 540 and the upper leg member 545. In some embodiments a kneeengagement surface of the knee pad 230 is forward of the line connectingthe pivot joints of the pivotable connection between the lower legmembers 540 and the upper leg members 545. Forward configurations mayaccount for the pivoting axis of a user's knee to be rearward of theknee engagement surface of the knee pad, providing better alignmentbetween the pivot joint of the natural-gait therapy device 500 and theuser's knee joint. In some embodiments, the forward location of the kneepad 230 may be adjustable to accommodate the anatomy of different users.For example, different sized shims may be insertable between the kneepad 230 and the knee engagement member 700. In the depicted embodiment,the knee pad 230 is positioned slightly forward of knee pivot joints ofthe natural therapy device so that the user's knee pivots in-line withthese pivot point.

In some embodiments, a heel lift will be cyclically performed inresponse to the elliptical motion of the foot rests. FIGS. 8A-8B depicta close-up view of a heel lift system. The foot rest in the depictedembodiment provides for adjustable foot height and for heel liftcoordination. The footrest height adjustment may be performed as in thedepicted embodiment. Two height adjustment controls, a forefoot heightadjustment control and a heel adjustment control are depicted. Theforefoot height may be adjusted by selecting a coupling distance betweena forefoot rest 800 and the foot motion platform 225. The forefoot rest800 may be adjustably coupled to the foot motion platform 225 bycoupling the foot motion platform 225 to one of a plurality of heightadjustment apertures 850 of a coupling member 855. In the depictedembodiment, two height adjustment apertures 850 are visible. In someembodiments three or more height adjustment apertures may be used. Theheel height may be adjusted by selecting a coupling distance between aheel rest 805 and a heel pivot lever 860. The heel rest 805 may beadjustably coupled to the heel pivot lever 860 by coupling the heel rest805 by selecting one of a plurality of height adjustment apertures 865.In the depicted embodiment, a spring loaded selection pin 870 may engageone of the plurality of height adjustment apertures 865, for example.

The heel pivot coordination may be performed as in the depictedembodiment. In the figures, a foot rest 215 includes the forefoot rest800 and the heel rest 805. The forefoot rest 800 and the heel rest 805are shown pivotably coupled at a heel pivot 810. The heel pivot controlincludes a heel rotation pivot axel 815 and a pivot control arm 820. Thepivot control arm 820 is rigidly coupled to the pivot axel 815. In thefigure, the pivot control arm 820 is depicted extending from the pivotaxel 815 at a ten o'clock orientation. If the pivot control arm 820 isrotated to a nine o'clock orientation, the heel rest 805 will rotate ina clockwise direction promoting heel lift. If, however, the pivotcontrol arm 820 is rotated to an eleven o'clock orientation, the heelrest 805 will rotate in a counterclockwise direction producing a heelfall. The pivot control arm 820 is actuated by a pivot control lever 825pivotably attached to a heel end of the lower leg member 540. As thedistance between the pivot point of the pivot control lever 825 at theheel end of the lower leg member 540 and the pivot axel 815 is reduced,the control arm 820 will move in a counter clockwise direction. And asthe distance between the pivot point of the pivot control lever 825 atthe heel end of the lower leg member 540 and the pivot axel 815 isincreased, the control arm 820 will move in a clockwise direction.Because a pivot connection 830 between the lower leg member 540 and thefoot rest 215 is aft and lower than the line connecting the pivot pointof the pivot control lever 825 at the heel end of the lower leg member540 and the pivot axel 815, the distance between the pivot point of thepivot control lever 825 at the heel end of the lower leg member 540 andthe pivot axel 815 will reduce when the angle between the lower legmember 540 and the foot rest 215 is reduced. Conversely, the distancebetween the pivot point of the pivot control lever 825 at the heel endof the lower leg member 540 and the pivot axel 815 will increase whenthe angle between the lower leg member 540 and the foot rest 215increases. In summary, as the lower leg member 540 is angled forwardtoward the foot rest 215, the heel rest will lift, and as the lower legmember 540 straightens increasing the angle between the lower leg member540 and the foot rest 215, the heel rest will fall.

FIGS. 9A-9B depict an exemplary transmission module for an exemplarynatural-gait therapy device. The functions of this exemplarytransmission module may include one or more of the following: i) unlockthe foot rests from the transfer/standing positions; ii) enable one ofthe leg cranks to rotate from a side-by-side/standing location to anopposition/natural-gait position; iii) when opposition is reached,automatically engage the second leg crank and fix its relative locationto be 180 degrees out of phase with the first leg crank; iv) disengagethe coupling of the two leg cranks into an opposition alignment, whilesimultaneously enabling both left and right side locks which locks eachleg cranks when it is positioned in the transfer/standing position.

In FIG. 9B, the transmission module is depicted in an exploded view. Thedepicted transmission module 900 is rotatably couple to a verticalsupport member 905 via and axel bearing 910. In some embodiments an axelbushing may be used to rotatably couple the transmission module 900. Adrive axel 915 is supported by the axel bearing 905 and coupled to aleft-leg drive gear 920 and a power drive gear 925. The power drive gear925 may be chain coupled to a hand drivetrain 505. The hand drivetrain505 may provide locomotion to a natural-gait therapy device 500. In someembodiments, locomotion may be provided by alternative means. Forexample, in some embodiment, an electric motor may provide locomotivepower to the power drive gear 925. In an exemplary embodiment, the driveaxel 910 may be driven by a locomotive force. The power drive gear 925and the left-leg drive gear 920 are depicted as coupled to the driveaxel 915 using a key 930. The key 930 may rotationally couple the powerdrive gear 925 and the left-leg drive gear 920 to the drive axel 915. Inthis way, when the power drive gear 925 is rotated, the drive axel 915may be rotated and the left-leg drive gear 920 may be rotated.

The depicted transmission module 900 includes a right-leg drive gear935. The right-leg drive gear 935 may not be rigidly coupled to thedrive axel 915 as is the left-leg drive gear 920. The right-leg drivegear 935 may be selectively coupled to the drive axel 915 when in anopposition alignment position with respect to the left-leg drive gear920. An opposition coupling mechanism 940 may couple the right-leg drivegear 935 to the drive axel 915 when the drive axel 915 is rotated to anopposition alignment position with respect to the left-leg drive gear920. Such an opposition alignment position may be attained when thetransmission module 900 is in an engaged mode. The engaged mode mayfacilitate a user's natural-gait motion, such as, for example, a walkinggait wherein the user's feet may be oppositionally aligned.

The transmission module 900 may have an engaged mode and a locked mode.When in the locked mode, both the right-leg drive gear 935 and theleft-leg drive gear 920 may be effectively locked into atransfer/standing position, in which a user's feet may be in aside-by-side position. A transmission engagement lever 945 may performthe engagement/locking operation of the transmission. When thetransmission engagement 945 lever is pulled, the transmission 900 may beengaged. This engagement may force a coupling hub 950 to slide along thedrive axel 915 away from the engagement lever 945. When the coupling hub950 slides away from the engagement lever 945, a coupling hub lockingaperture 955 (in a back-side of the coupling hub in this depiction) maydisengage a hub locking member 960. In the FIG. 9A depiction, the hublocking aperture 955 in the coupling hub 950 has the hub locking member960 inserted therein. But when the coupling hub 950 is slid away fromthe engagement lever 945, the coupling hub 950 clears the hub lockingmember 960. The coupling hub 950 is slidably coupled to the drive axel915 via a star gear 965. Within the coupling hub 950 is a star gearaperture 970, within which the star gear 965 slidably engages thecoupling hub 950. The coupling hub 950 and drive axel 910 arerotationally coupled via the star gear 965 and complementary star gearaperture 970. Thus, regardless of the mode, engaged or locked, thecoupling hub 950 may be rotationally locked to the drive axel 915. Thus,when the coupling hub 950 is locked, the drive axel 915 is locked, theleft-leg drive gear 920 is locked and the power drive gear 925 islocked.

When the coupling hub 950 is engaged (slid along the axel), not only isthe hub locking member 960 disengaged from the locking aperture 955 inthe coupling hub 950, but the right-leg drive gear 935 is unlocked fromthe coupling hub 950. A right gear locking member 975 disengages from acomplementary locking aperture 980 in the right-leg drive gear 935. Whenboth locking members 960, 974 are disengaged, both the left-leg drivegear 920 and the right-leg drive gear 935 are free to rotate. Thetransfer/standing position of the foot rests 215 may be at the lowestelevation of the elliptical cycle. The weight of the user may keep thefoot rests 215 in the transfer/standing position even when unlocked bythe transmission module 900.

When the coupling hub 950 is locked, both locking members 960 975 may belocked. The locking member 960 may lock the coupling hub 950 so that thecoupling hub 950 cannot rotate. As the coupling hub 950 may berotationally coupled to the axel 915 and in turn, the left-leg drivegear 920, the locking member 960 may lock the left leg into a lockedtransfer standing position. The locking member 975 may lock the couplinghub 950 to the right-leg drive gear 935. As the coupling hub 950 isrotationally coupled to the left-leg drive gear 920, the locking member975 may lock the left-leg drive gear to the right-leg drive gear. Thelocking alignment of the locking member 975 may be such that theleft-leg is aligned in a side-by-side alignment with the right-leg whenin the locking member 975 is engaged. When both locking members 960, 975are engaged, both of the user's legs may be locked into a side-by-sidetransfer/standing position. This locked transfer/standing position maylock the foot rests in a transfer position, which may be that positionthat the feet are in a specific anatomic position with respect to theknees of the user, so as to be able to transition between a sittingposition and a standing position without compromising anatomic motion.The locking of the feet position may substantially inhibit feet motionboth in the longitudinal direction and differential motion of both feet.The locked transfer position may be the lowest elevation positions ofboth of the foot motion platforms 505 over their periods of ellipticalorbits. At the lowest elevation positions, gravity may assist the userin returning to the transfer position when the locking members 960, 975are both disengaged.

When the transmission module 900 is in the engaged mode, and both theleft-leg and right-leg drive gears 920, 935 are unlocked, the handdrivetrain may now provide drive power to the main power gear 925. Whenthe main power gear 925 is rotated, the left-leg drive gear 920 issimultaneously rotated. The left-leg drive gear 920 then may be chaincoupled to the left-leg crank gear 435, which in turn moves the leftleg. The right-leg drive gear 935 may remain uncoupled from the driveaxel 915 until the coupling hub 950 is rotated into the oppositioncoupling position. When the user's left leg is rotated to a position inwhich the left leg is 180 degrees out of phase as the right leg, aspring loaded opposition coupling member 983 couples the coupling hub950 to the right-leg drive gear 935. Further rotation of the power drivegear 925 now will rotate both the left-leg and right-leg drive gears920, 935. This in turn may rotate both the left and right foot rests 215proving power for their elliptical orbits. In some embodiments, aone-to-one ratio of gear teeth between the leg drive gears 920, 935 andthe left and right chain gears 430, 435 may ensure that each turn of aleg drive gear 920, 935 produces a single turn of each of the chaingears 420, 435. This one-to-one ratio between the leg drive gears 920,935 and the chain gears 420, 435 may permit the transmission to reliablylock the foot rests into both the foot-opposition position and theside-by-side position.

Various gear ratios may be used to make the locomotion operation easieror more difficult. In some embodiments, each hand powertrain 505rotation may produce a single rotation to the power drive gear 925. Insome embodiments, to make it easier to hand-locomote the natural-gaitoperation, two rotations of the hand powertrain 505 may produce a singlerotation of the power drive gear 925. Various turns ratios may be usedto provide users with varying degrees of hand strength proper levels ofeffort for good natural-gait therapy. In an exemplary embodiment, aselectable gear transmission module may provide user electability as tothe gear ratio for use. In an exemplary embodiment, a bicycle type ofderailleur may be used to facilitate gear ratio changes.

FIG. 10 depicts a perspective view of an exemplary natural-gait therapydevice. In the FIG. 10 embodiment, an exemplary natural-gait therapydevice 1000 includes a locked/engagement lever 1005. Thelocked/engagement lever may couple to the transmission engagement lever.When in a forward position, the locked/engagement lever may control thetransmission to be in the locked position, in which the user may be in astanding position with side-by-side feet. When in the rearward position,the locked/engagement lever may put the transmission into the engagedposition, in which the user may be in a walking position withoppositionally aligned feet. The depicted natural-gait therapy device1000 also includes a lifting pump handle 1010. The lifting pump handlemay control the lifting and lowering of the seat 1015 and a user's bodyseated in the seat 1015. For example, when the lifting pump handle ispulled in a rearward direction, the hydraulic pump may raise the seat1015 a quantified amount. Each pull of the lifting pump handle 1010 mayfurther raise the seat 1015. The lifting pump handle may ratchet theseat toward a standing position as the lifting pump handle is pulled toand fro between a mid-forward position and a rearward position. If,however, the handle is pushed to a far-forward position, the hydraulicpump may then lower the seat to its transfer position. The depictedlocked/engagement lever 1005 extends to the lateral side of thenatural-gait therapy device impeding the throw of the lifting pumphandle 1010. This imposition may perform an interlocking function. Forexample, if the locked/engagement lever 1005 is in the rearward positionengaging the transmission, and the user attempts to push the liftingpump handle 1010 to its far-forward position, the lifting pump handle1010 may encounter and contact the lateral extension of thelocked/engagement lever 1005. If the user continues pushing the liftingpump handle 1010 to reach its far-forward position, thelocked/engagement lever 1005 may be pushed to its forward position,locking the transmission. The foot position of the foot rests may thenbe transferred to their side-by-side position. A side-by-side footposition is the safe position for permitting a user to transitionbetween a standing position and a sitting position. This interlockingfeature may provide a safe side-by-side foot position for a user whoattempts to sit before intentionally changing the transmission fromengaged mode to locked mode.

Various means for interlocking the locked transmission mode to the pumprelease operation may be performed. In some embodiments, the interlockmay be performed using electrical signals. For example, a positiondetector may generate an electronic signal indicative of the seat heightposition. If the seat height position begins to descend from thestanding position, an electronic release of the feet positions may beinitiated. In some embodiments, the pump may be prevented fromperforming a sitting operation until a user locks the transmission, forexample.

FIG. 11 depicts a perspective view of an exemplary natural-gait therapydevice having independent upper and lower chain tensioning mechanisms.In the FIG. 11 embodiment, an exemplary natural-gait therapy device 1100includes a vertical support member 905 that is adjustably attachable tothe cage 255. The vertical support member 905 provides support for thetransmission module 900. The adjustable attachment may facilitate thetensioning of lower coupling chains which may couple the left-leg andright-leg drive gears 920, 935 to the left and right chain gears 430,435. The depicted embodiment includes two slotted connection points1100, 1105 and a screw tensioning module 1110. A threaded flange 1115 iscoupled to the cage 255. A screw 1120 is threaded into the flange andimpinges upon a flat flange 1125 that is attached to the verticalsupport member 905. When the screw is turned in a clockwise direction,the impinging end of the screw may push the vertical support member inan upward direction, thereby increasing the tension of the lowercoupling chains. When the chains have sufficient tension for propercoupling operation, screws may be inserted into the slotted connectionpoints 1100, 1115 to secure the vertical support member 905 to the cage255 in the chain tensioned position.

The hand powertrain 505 is shown adjustably connected to the verticalsupport member 905 in a similar fashion. The depicted hand powertrain505 includes a hand drive gear 1130. An upper coupling chain may couplethe hand drive gear 1130 to the power drive gear 925 of the transmissionmodule 900. The depicted hand drive gear 1130 may have fewer teeth thanthe power drive gear 925 so as to facilitate the ease of hand locomotionof a natural-gait, as depicted in FIG. 11. The adjustable attachment mayfacilitate the tensioning of the upper coupling. The depicted embodimentincludes two slotted connection points 1135, 1140 and a screw tensioningmodule 1145. A threaded flange 1150 is coupled to the vertical supportmember 905. A screw may be threaded into the flange and may impinge upona flat flange 1155 that is attached to the hand powertrain 505. When thescrew may be turned in a clockwise direction, the impinging end of thescrew may push the vertical support member in an upward direction,thereby increasing the tension of the upper coupling chain. When thechain has sufficient tension for proper coupling operation, screws maybe inserted into the slotted connection points 1135, 1140 to secure thevertical support member 905 to the hand powertrain 505 in the chaintensioned position.

Although various embodiments have been described with reference to theFigures, other embodiments are possible. For example, in someembodiments, a bio stimulator may include a phase detection module. Anexemplary phase detection module may provide a bio-stimulator unitinformation regarding the current phase of a natural-gait operation. Inthis way, the user may control the speed and manner of the natural-gaittherapy, and the phase detection module will provide phase informationin response to a user-controlled natural-gait phase. In someembodiments, a plurality of neurological stimulators may be controlledby a bio-stimulator unit. For example, one or more muscles may bestimulated by each of the neurological stimulators. In some embodiments,three or more neurological stimulators may be controlled for each leg ofa user. In an exemplary embodiment, a quadriceps stimulator, a hamstringstimulator, and a calf stimulator may be controlled by an exemplarybio-stimulator unit.

In an exemplary embodiment, a bio stimulator may have parameters thatare varied in response to one or more metrics of the gait cycle. Forexample, the intensity of a neurological stimulation may increase as thefrequency of the gait increases. In some embodiments, a neurologicalstimulation may begin at a beginning phase associated with a gait cycleand end with an ending phase associated with a gait cycle. The beginningand/or ending phase may advance or retard as the frequency of the gaitcycle increases, for example. The location of the muscle or musclegroups, the intensity, the waveform, the frequency of stimulation allmay respond to the various gait cycle metrics, for example.

FIGS. 12A-12C depict an exemplary sit-to-stand therapy device. In FIG.12A, an exemplary sit-to-stand therapy device 1200 is depicted in aperspective view. The depicted sit-to-stand therapy device 1200 includesan adjustable frame 1202, a pivotable seat assembly 1204 and means forpivoting the pivotable seat assembly 1204 from a sitting position to astanding position. In the depicted embodiment, the pivoting meansincludes a hydraulic pump system 1206. In some embodiments, the pivotingmeans may include an electric motor, for example. In an exemplaryembodiment, the pivoting means may include a hydraulic piston that iselectrically controlled. In some embodiments a pneumatic system mayassist pivoting of the pivotable seat assembly 1210. A mechanicalratchet may pivot the pivotable seat assembly in some embodiments.

The adjustable frame 1202 of the depicted embodiment includes aground-engaging base assembly 1208 and a vertical assembly 1210. Theground-engaging base assembly 1208 includes two transverse groundcontacting members 1212 connected by a longitudinal member 1214. Each ofthe transverse ground contacting members 1212 has foot pads 1216 locatedat lateral ends 1218 of each transverse ground contacting member 1212.The foot pads 1216 may be Z-height adjustable, for example. Z-heightadjustable foot pads 1216 may facilitate leveling of the sit-to-standtherapy device 1200. The longitudinal member 1214 has a longitudinalaxis 1220 (e.g. X-axis) that is substantially coplanar with a mediansagittal plane of a user seated upon the pivotable seat assembly 1204.By having the longitudinal member 1214 substantially coplanar with themedian sagittal plane of a seated user, a wheel chair may be positionswith a front wheel of the wheelchair adjacent to the longitudinal member1214 and with a wheelchair's seat positioned adjacent to a seat bottom1222 of the pivotable seat assembly 1204. The coplanarity of thelongitudinal member 1214 and the median sagittal plane of a seated usermay advantageously facilitate the close juxtapositioning of a wheelchairto the seat bottom 1222 from either side of the sit-to-stand therapydevice 1200.

The depicted vertical assembly 1210 of the adjustable frame 1202 furtherincludes a vertical beam 1224 which is braced by a bracing beam 1226. Atorso engagement assembly 1228 projects from the vertical beam 1224toward a user when seated in the pivotable seat assembly 1204. The torsoengagement assembly 1228 includes a torso engagement pad 1230 and anadjustable connecting beam 1232. In some embodiments the torsoengagement pad 1230 can be adjusted in the Y-direction. In someembodiments, the torso engagement pad 1230 can be adjusted in theZ-direction. The adjustment of the torso engagement pad 1230 mayadvantageously facilitate comfortable positioning of the torsoengagement pad 1230 to a user's torso, when in the standing position.

The depicted vertical assembly 120 of the adjustable frame 1202 furtherincludes a stand 1234. In some embodiments, the stand may providesecurement devices to secure an object to the stand. For example, aledge may support a base of a book upon the stand 1234. In someembodiments an electronic device may be secured upon the stand 1234. Forexample, a tablet computer may be secured to the stand 1234.

The depicted vertical assembly 1210 of the adjustable frame 1202 furtherincludes a seat-assembly connecting beam 1236 projecting from thevertical beam 1224. The seat-assembly connecting beam 1236 supports aknee engagement assembly 1238. The knee engagement assembly 1238 may beadjustable. For example, the knee engagement assembly 1238 may bemovable in the X-direction. An X-direction adjustment may facilitate acollinear positioning of knee pivot points as will be described below.The knee engagement assembly 1238 has two knee pads 1240. The separationdistance (Y-direction separation) and/or the Z-height of the knee pads1240 may be adjustable. In some embodiments, the knee pads 1240 may beslidably coupled to the knee engagement assembly 1238. In suchembodiments, the knee pads may freely move in the Z-direction as theuser is pivoted from a sitting position to a standing position. Suchfree movement may accommodated incidental changes in the Z-height of auser's knees as the user is pivoted from a sitting position to astanding position, for example.

Height adjustable foot rests 1242 are shown couple to the verticalassembly 1210. The height of the foot rests 1242 can be adjusted byselecting a pair of mounting holes 1244 for use in affixing the footrests 1242 to the vertical assembly 1210. In some embodiments, the footrests 1242 may be adjustably positioned along the longitudinal axis(X-direction adjustability).

The hydraulic pump system 1206 includes an operating handle 1246 thatmay be used to operate the hydraulic pump 1248. In some embodiments, theoperating handle 1246 may be pulled back and forth (e.g. in theX-direction) to deploy a piston 1250 from a pump housing 1252 (asdepicted in FIG. 12C). In an exemplary embodiment, pushing the pumphandle to a far forward position (from a user's perspective) may permitthe piston 1250 to be forced back into the pump housing 1252. A person'sbodyweight may facilitate the forcing of the piston 1250 into the pumphousing 1252, for example.

In FIGS. 12A-12B, the sit-to-stand therapy device is shown in thesitting position and the standing position, respectively. In both FIGS.12A-12B, the knee engagement assembly 1238 has been hidden so as tofacilitate the viewing of the pivotable seat assembly 1204. In FIG. 12B,the pivotable seat assembly 1204 includes a step-over connecting beam1254 pivotable connected at a proximal-end pivot point 1256 to theseat-assembly connecting beam 1236. The step-over connecting beam 1254is connected at a distal end to the seat bottom 1222. A seat-backattitude control assembly 1258 may maintain an attitude of a seat back1260 throughout a movement of the pivotable seat assembly 1204 from asitting position to a standing position. The step-over connecting beam1254 has been made semi-transparent in FIGS. 12B-12C so that theseat-back attitude control assembly 1258, which travels within a hollowregion of the step-over connecting beam 1254, can be seen.

When the pivotable seat assembly 1204 is in the sitting mode as isdepicted in FIG. 12B, the step-over connecting beam 1254 may betraversed by the user's feet without requiring the feet to be raisedhigh above an elevation of the foot rests 1242. The step-over connectingbeam 1254 connects the seat bottom 1222 to the adjustable frame 1202.When in the sitting mode, the step-over connecting beam 1254 traverses apath from the knee pivot location down (Z-direction) to a proximallocation near the floor and then longitudinally (X-direction) near aground surface to a location rearward of the foot rests 1242, and thenupward (Z-direction) to the seat bottom 1222. Such a traversal mayprovide leg space in front of the seat bottom 1222 for a user tolaterally (Y-direction) transfer a leg across the median sagittal plane.

Leg transfer accommodating leg space may be improved by locating alongitudinal portion 1262 of the path of traversal of the step-overconnecting beam as near to the longitudinal member 1214 of the baseassembly 1208 as is practical. In an exemplary embodiment, for example,the step-over connecting beam 1254 may touch the longitudinal member1214 when in the sitting position. A pivot descending portion 1264 ofthe step-over connecting beam 1254 may travel forward in its descentfrom the pivot point 1256. Such a forward angled profile may provideimproved leg space for a user to laterally (Y-direction) transfer auser's foot across the median sagittal plane to a foot rest 1242.

A segmented central axis of the depicted step-over connecting beam 1254is substantially coplanar with the median sagittal plane of the user,when seated. The segmented central axis of the step-over connecting beam1254 is substantially coplanar with the longitudinal axis 1220 of thelongitudinal member 1214 or the base assembly 1208. Wheelchair access tothe sit-to-stand therapy device may not be further inhibited by thestep-over connecting beam 1254, due to the coplanarity of the segmentedcentral axis of the step-over connecting beam 1254 and the longitudinalaxis 1220 of the longitudinal member 1214.

In some embodiments, a support block may be interposed between thelongitudinal member 1214 and the step-over connecting beam 1254. Thesupport block may determine a seat bottom height above a ground surface,for example. In some embodiments the support block may be adjustable.For example, the seat height may be adjustably set above a floor surfacefor accommodating transfer from wheelchairs of different seat heights.In some embodiments, the support block may be replaceable. For example,a support block may be selected from a set of support blocks ofdifferent dimensions corresponding to different seat heights. In anexemplary embodiment, a seat height may be set by a limiting memberinterposed between the brace member 1226 and the step-over connectingbeam 1254. In some embodiments, dimensions of the hydraulic pump 1248with the piston 1250 fully retracted into the piston housing 1252 maydetermine the seat height, when in the sitting position.

In the FIG. 12B embodiment, the foot rests 1242 may be verticallyadjustable so that a knee-height distance 1266 between the footrests1242 and the pivot point 1256 may be substantially equal to the distancebetween a user's sole of the foot to a user's knee pivot point. When auser has placed a user's feet in the foot rests 1242 and the user'sknees against the knee rests 1240, the pivot points of the user's kneesmay be collinear with the pivot point 1256 of the pivotable seatassembly 1204. When the pivot points are so aligned, a user's seat mayrest upon the seat bottom 1222 at a fixed distance from the pivot point1256. As the seat bottom 1222 is raised to a standing position, thefixed distance between a pivot points of the user's knee and the user'sseat may be substantially equal to the fixed distance between the pivotpoint 1256 and the seat bottom 1222 at the point of contact with theuser's seat. The substantially equal distances between the contactingpoints of the user's body and the contacting points of the sit-to-standtherapy device may advantageously facilitate a user's elevation from asitting position to a standing position without subjecting thecontacting body features to sheer forces.

In FIG. 12C, the pivotable seat assembly 1204 is depicted in a standingposition. The step-over connecting beam 1254 has been pivoted about apivot point 1256 by the hydraulic pump 1248. In the depicted embodiment,the pivotable seat assembly 1204 is configured as a class 3 lever,wherein the effort is between the fulcrum and the resistance. In theexemplary embodiment, the hydraulic pump 1248 serves as the effort, andthe pivot connection 1256 serves as the fulcrum. The resistance is theweight on the distal end of the pivotable seat assembly 1204.

The seatback attitude control assembly 1258 includes a first linkagemember 1268 that is pivotably coupled at a proximal end pivot point 1270to the seat-assembly connecting beam 1236. The first linkage member 1268is then connected at a distal end to a pivot lever 1272 at an effortlocation. The pivot lever 1272 has a pivotable fulcrum 1274 connected tothe step-over connecting beam 1254. A second linkage member 1276 isconnected at a proximal end to an effort location of the pivot lever1268. The second linkage member 1276 is then connected at a distal endto a seatback control lever 1278 at an effort location. A fulcrum 1280of the seatback control lever 1278 is pivotably connected to the seatbottom member 1282. The described mechanism of the seatback attitudecontrol assembly 1258 may maintain the seatback 1260 in a substantiallyvertical orientation independent of an elevation of the seat bottom1222. The first 1268 and second 1276 linkage members as well as thepivot lever 1272 run substantially within a hollow cavity of thestep-over connecting beam 1254. By locating portions of the seatbackattitude control assembly 1258 within a cavity of the step-overconnecting beam 1254, the pivotable seat assembly 1204 may present asmall form factor to facilitate a user's entry and exit from thesit-to-stand therapy device 1200.

The depicted sit-to-stand therapy device 1200 may be used by individualswho are unable and/or have difficulty rising from a sitting position toa standing position. The sit-to-stand therapy device 1200 may support astanding user and/or help the user remain standing. A user's seat may betransferred from a wheelchair to the seat bottom 1222, for example. Auser's feet may be transferred into the adjustably located foot rests1242. The seat bottom 1222 may then be raised to lift the user to astanding position. The user may ratchet the pump handle 1246 to ratchetthe seat bottom 1222 to a desired vertical position and/or horizontalposition. As the seat bottom 1222 may be pivoted from the sittingposition to the standing position, a normal vector of an seat-engagingsurface of the seat bottom 1222 may rotate from a substantially verticalorientation (e.g. aligned with Z-direction) to a substantially forwardlateral orientation (e.g. aligned with X-direction). When in thestanding position, the normal vector of the engagement surface of theseat bottom 1222 and a normal vector of an engagement surface of theseat back 1260 may be oriented in substantially the same direction. Whenin the standing position, the seat bottom 1222 and/or the seat back 1260and the torso engagement pad 1230 may substantially oppose one another.When so opposed, the torso engagement pad 1230 and the seat bottom 1222and/or seat back 1260 may sandwich a user therebetween.

FIG. 12D depicts the sit-to-stand therapy device 1200 in a standingconfiguration with the knee pad assembly 1238 unhidden. The arm rests1284 may facilitate the lateral securing of a user's body within thesit-to-stand therapy device 1200, especially when in the standingposition. A user would be make contact with the foot rests 1242, theknee pads 1242, the torso engagement pad 1230 and the seat bottom 1222.Note that, in the depicted embodiment, arm rests 1284 may be pivotedwith respect to the seat bottom 1222. The arm rests 1284 may prevent theuser from laterally falling when in the standing position.

Facilitating a user, who are otherwise unable, to stand may have manypositive health benefits. For example, by providing weight bearing onthe user's legs, bone integrity may be improved. Bone density, can beimproved when bones are forced to bear loads. A user's circulation mayimprove by exercising in such a manner. Improved renal function mayresult from regular use. In some circumstances improved range of motioncan result.

FIGS. 13A-13B depicts a perspective view of an exemplary natural-gaittherapy system.

In FIG. 13A, an exemplary natural-gait therapy system 1300 is in asitting position. The depicted natural-gait therapy system 1300 includesan exemplary protective cover 1305 that covers many of the moving partsof the natural-gait therapy system 1300. The depicted natural-gaittherapy system 1300 includes a sit-to-stand locomotion system 1310, anatural-gait locomotion system 1315, and a stand-to-walk transmissionsystem (obscured by the protective cover 1305 in this perspective view).In some embodiments, the sit-to-stand locomotion system 1310 may besimilar to systems described with reference to FIGS. 12A-12D.

In FIG. 13B, an exemplary natural-gait therapy system 1320 is in asitting mode. The depicted natural-gait therapy system 1320 includes anexemplary protective cover 1325 that covers many of the moving parts.The depicted natural-gait therapy system 1320 includes a sit-to-standlocomotion system 1330, a natural-gait locomotion system 1335, and astand-to-walk transmission system (obscured by the protective cover 1325in this perspective view). In some embodiments, the sit-to-standlocomotion system 1330 may be similar to systems described withreference to FIGS. 12A-12D. The natural-gait locomotion system will bedescribed below, with reference to FIGS. 14A-14D.

FIGS. 14A-14D depict an exemplary natural-gait therapy system without aprotective covering and without a pivotable seat assembly. Theprotective covering and pivotable seat assembly have been hidden inthese figures so that a natural-gait locomotion system may be betterviewed. The FIGS. 14A-14D depictions show a natural-gait therapy systemin a walking mode. When in the walking mode, the two foot rests areoperatively coupled at opposite phases of a natural-gait cycle. Forexample, when one footrest is forward moving, the other footrest will bebackward moving. FIG. 14A depicts an exemplary natural-gait therapysystem 1400. The depicted natural-gait therapy system 1400 includes anatural-gait locomotion system 1402. The natural-gait locomotion system1402 includes a toe-position control system 1404, a forefoot-anglecontrol system 1406, knee-position control system 1408 and a heel-liftcontrol system 1410.

The toe-position control system 1404 includes a left crank arm 1412 thatis operatively coupled and out-of-phase with a right crank arm 1414. Theleft 1412 and right 1414 crank arms each rotate in response tolocomotion of a power system 1415. The left 1412 and right 1414 crankarms each rotate the about a crank shaft axis. Each crank arm 1412, 1414is coupled to a crank shaft at a proximal end 1416. Each crank arm 1412,1414 is pivotably coupled to a drive arm 1418 at a distal-end pivotpoint 1420. The drive arms 1418 are pivotably coupled to the crank arms1412 at a proximal end. Each drive arm 1418 is slidably coupled to alongitudinal frame member 1422 at a distal end.

Various means for slidably coupling the distal end of the drive arm 1418to the longitudinal frame member 1422 can be realized. For example, inthe depicted embodiment, a rolling wheel 1424 is coupled to the distalend of the drive arm 1418. The longitudinal frame member 1422 has aguide channel 1426 in which the rolling wheel 1424 may travel. Therolling wheel 1424 may have an axle 1428 laterally projecting from oneside or both sides of the rolling wheel 1424. The projecting axle 1428may extend beyond the guide channel 1426 and within a cavity in thelongitudinal frame member 1422. This projecting axle 1428 may serve toretain the distal end of the drive arm 1418 within the guide channel1426, for example.

As the crank arms 1412 rotate about the axis of the crank shaft, thepivot point 1420 traverses a circular orbit 1430 about the crank shaftaxis. Thus, the motion of the proximal end of the drive arm 1418 issubstantially circular at the pivot point 1420. If one assigns theorigin of an X-Z coordinate system to be at the crank shaft axis, thecircular orbit 1430 can be described as:

x ₁ ² +z ₁ ² =r ²

Here, r is the radius of the pivot point with respect to the crank shaftaxis.

The distal end of the drive arm 1418 is substantially linear as a resultof the slidable coupling. The position of the distal end of the drivearm 1418 is linear, but related to the circular position 1430 of thepivot point 1420. The z coordinate of the distal end is fixed (z₂). Butthe x coordinate of travel is related to the circular coordinate systemby way of the distance, L, form the pivot point 1420 to the axel 1428 ofthe rolling wheel 1424:

x ₂ =x ₁+√{square root over (L ²−(z ₂ −z ₁)²)}

Thus, as the pivot point 1420 is driven in its circular orbit 1430, theaxel 1428 of the rolling wheel 1424 is linearly driven with fixed zcoordinate, z₂, and a reciprocating x coordinate, x₂.

A foot rest 1432 is pivotably coupled to the drive arm 1418 at alocation between the pivot point 1420 and the axel 1428 of the rollingwheel 1424. The foot rest 1432 is thus driven at a pivot point 1434 bythe drive arm 1418. The path of travel of the pivot point 1434 isneither perfectly circular, nor perfectly linear, but some relation toboth of these. The coordinates of travel for the pivot point isapproximately given by:

(αx ₁+(1−α)x ₂ ,αz ₁+(1−α)z ₂)

Here α is the ration of the distance from the pivot point 1418 to thepivot point 1434 and the distance from the pivot point 1418 to the axel1428 of the rolling wheel 1424. This path of motion of the pivot point1434 of the foot rest 1432 may approximate a natural gait motion of ahuman. In the depicted embodiment, the toe-position control system 1404responds to power system 1415 and positions the foot rest 1432 at apredetermined location for each phase of a natural-gait cycle.

FIG. 14B depicts the exemplary natural-gait therapy system 1400 shown inFIG. 14A. This figure will be used to describe the forefoot anglecontrol system 1406. The forefoot angle control system 1406 includes apendulum member 1436 pivotably coupled to the frame at a proximal-endpivot point 1428. The pendulum member 1436 is also pivotably coupled toa foot rest beam 1440 at a distal-end pivot point 1442. The travel ofthe distal-end pivot point 1442 is along a circular arc 1444 about theproximal-end pivot point 1438. The circular arc 1444 lies on the circledefined by:

(x ₄ −x ₃)²+(z ₄ −z ₃)² =P ²

Here, P is the radial distance of the pivot point 1442 from the pivotpoint 1438 of the pendulum members 1436. The point (x₃, z₃) is thecoordinate of the pivot point 1438. The coordinate (x₄, z₄) describe thepath of travel for the pivot point 1442. The angle of a forefoot portion1446 of the foot rest 1432 is determined by the relative heights(z-coordinates) of the pivot point 1442 and the pivot point 1434 (e.g.the relative values of z4 and αz₁+(1−α)z₂).

The exemplary pendulum members 1436 have a bent-knee shape so as topermit them to travel swing back and forth without impinging the powersystem 1415. Because the pendulum members 1436 are shaped to avoid otherelements of the natural-gait therapy system 1400, the pendulum membersmay located laterally interior to the crank arms 1412, 1414. Suchinterior locations of the pendulum members 1436 may result in a narrowform factor for the natural-gait therapy system 1400. In the depictedembodiment, the forefoot angle control system 1406 responds to movementof the toe position control system 1404 and provides a predeterminedangle of the forefoot portion 1446 of the foot rest 1432 at each phaseof the natural-gait cycle.

FIG. 14C depicts the exemplary natural-gait therapy system 1400 shown inFIGS. 14A-14B. This figure will be used to describe the knee-positioncontrol system 1408. The knee-position control system 1408 includes anupper leg member 1448 pivotably attached to the frame at a hip-end pivotpoint 1450. The upper leg member 1448 is also pivotably coupled to alower leg member 1452 at a knee-end pivot point 1454. The lower legmember 1452 is pivotably coupled to the foot rest 1432 at an ankle-endpivot point 1456.

As the foot rest 1432 is driven along its path of travel as describedabove, the knee-end pivot point 1454 may be propelled along its own pathof travel. In response to the coordination of the toe-position and theforefoot angle of the forefoot portion 1446 of the foot rest 1432, theankle-end pivot point 1456 moves along a path of travel. As theseparation distance between the ankle-end pivot point 1456 and thehip-end pivot point changes, a knee joint 1458 may flex and/or unflex.The x-z alignment of the various pivot points with correspondinganatomical pivot points of a user facilitate a natural-gait motion ofoperation. Thus, the relative position of the ankle-end pivot point 1456with respect to the foot rest 1432 may correspond to a relative positionof an ankle joint to a sole of a foot of a human. And again, therelative lengths of the lower leg member 1448 to the upper leg member1448 may correspond to the relative lengths of a human's lower leg andupper leg.

The upper leg member 1448, knee joint 1454 and lower leg member 1452 arelaterally located outside the foot rests 1432 so as not to interferewith a human user positioned upon the foot rests 1432. Thus, the kneepads 1460 project inward from the knee-position control system 1408. Insome embodiments, the knee pads 1460 are supported by a projecting beamcoupled to the lower leg members 1452. In some embodiments the knee pads1460 are supported by a projecting beam coupled to the upper leg members1448. In an exemplary embodiment, the knee pads 1460 are supported by aprojecting beam coupled to the knee joint 1458. In the depictedembodiment, the knee-position control system 1408 responds to thecoordinated movements of the toe position control system 1404 and theforefoot-angle control system 1406 and provides a predeterminedpositioning of the knee pads 1460 at each phase of the natural-gaitcycle.

FIG. 14D depicts the exemplary natural-gait therapy system 1400 shown inFIGS. 14A-14C. This figure will be used to describe the heel-liftcontrol system 1410. The heel-lift control system 1410 includes acontrol arm 1462 pivotably coupled to the lower leg member 1452 at aproximal-end pivot point 1464. The control arm 1462 is also pivotablycoupled to a heel portion 1466 of the foot rest 1432 at a distal-endpivot point 1468. As the lower leg member 1452 pivots about the heel-endpivot point 1456, the angle of the lower-leg member 1452 with respect tothe forefoot portion 1446 of the foot rest 1432 changes. As this anglechanges, the proximal end pivot point 1464 travels along an arc aboutthe heel-end pivot point 1456. The control arm 1462 in turn moves andcauses the distal-end pivot point 1468 to travel on an arc about a healpivot point 1470. Because the distal-end pivot point 1468 is pivotablycoupled to the heel portion 1466 of the foot rest, when the distal-endpivot point 1468 travels on its arc, the heel portion 1466 of the footrest 1432 lifts and/or falls.

The amount of lift that results from a given angle between the lower legmember 1452 and the forefoot portion 1446 of the foot rest 1432 may bedetermined by the ratio of the separation distance of the heel-end pivotpoint and the proximal-end pivot point to the separation distance of thedistal-end pivot point to the heal pivot point 1470. In the depictedembodiment, the heel-lift control system 1410 responds to thecoordinated movements of the toe position control system 1404, theforefoot-angle control system 1406, and the knee-position control system1408 and provides a predetermined amount of lift to the heal portion1466 of the foot rest 1432 at each phase of the natural-gait cycle.

FIG. 15 depicts an exemplary embodiment of a knee position controlsystem with hyperextension protection. An exemplary therapy-system kneejoint 1500 is depicted that includes an upper-leg connecting member 1502pivotably coupled to a lower-leg connecting member 1504 at a knee pivotpoint 1506. The upper 1502 and lower 1504 connecting members havecomplementary rotational limiting features for preventing hyperextensionof a user's knee joint. The upper 1502 and lower 1504 connecting membershave been drawn in transparent fashion so as to permit view of thesecomplementary rotational limiting features. One of the upper 1502 orlower 1504 connecting members has a rotational slot 1508, while theother has a projecting feature 1510 that projects into the rotationalslot 1508 when the two connecting members 1502, 1504 are pivotablycoupled to each other.

In the depicted embodiment, three rotational slots 1508 are present. Insome embodiments more or fewer slots may be provided. Each slot providesan arc of travel for the projecting features 1510 that project therein.The arc of travel may permit the knee joint to pivot over apredetermined range of angles. For example, the relative angle betweenan upper leg member 1512 and a lower leg member 1514 may be freelypermitted from 90 degrees to 180 degrees. But hyperextension of the kneemay be prevented by the limited travel of the projecting features 1510within the slots 1508. In some embodiments, the permitted angles of kneepivot may correspond to a range of angles encountered throughout a cycleof the natural gate motion as described above.

FIGS. 16A-16B depict an exemplary stand-to-walk transmission system.FIGS. 16A-16B make a transmission housing transparent so as to makevisible the elements within. FIG. 16A depicts a stand-to-walktransmission system 1600 in a standing mode. FIG. 16B depicts thestand-to-walk transmission system 1600 in a walking mode. The basicprinciple of the stand-to-walk transmission is to provide two phasescoupling a right drive axle 1605 to a left drive axle 1610—0 degrees and180 degrees.

The right drive axel 1605, and the left drive axle 1610 may be coupledto permit independent rotation of each drive axle 1605, 1610. The rightdrive axle 1605 and the left drive axle 1610 are axially aligned. Insome embodiments, a cylindrical centering rod may be inserted within acylindrical axial cavity in one or both drive axles 1605, 1610 toprovide axial alignment. In an exemplary embodiment, one of the driveaxels 1605, 1610 may have a cylindrical axial lumen, and the other driveaxle 1610, 1605 may be solid, but have one side machined so as to beinsertable into the cylindrical axial lumen of the other drive axle.

The right drive axle 1605 is coupled to a right crank arm 1615. The leftdrive axle 1610 is coupled to a left crank arm 1620. Each of the crankarms 1615, 1620 control the natural gait motion of the foot rests 1432and knee pads 1460 as described above. A natural-gait motion is‘natural’ when the left side foot rest 1432 and knee pad 1460 areapproximately 180 degrees out of phase with the right side foot rest1432 and knee pad 1460. Thus, to provide a natural-gait phaserelationship between the two otherwise independently rotatable crankarms, the transmission may provide a means for locking the transmissionin a 180 degree phase relation.

But when a person stands, the person's feet are normally side by side or“in phase.” And when a person is in the process of transitioning from asitting position to a standing position or vice-versa, a person oftenpositions the feet side-by-side. A side-by-side foot arrangement mayprovide a safe configuration for sitting or standing, as each side ofthe body may move in a symmetrical fashion about a median sagittalplane. Thus, to provide a natural position for transitioning a user froma sitting position to a standing position and/or vice-versa, thetransmission may provide a means for locking the transmission in a 0degree phase relation.

To accomplish these two modes of phase-locking the left drive axle 1605to the right drive axle 1610, each drive axle 1605, 1610 has acomplementary locking member. In the depicted embodiment, the left driveaxle 1610 is rigidly coupled to a left locking member 1625, in thisembodiment in the form of a solid disk. The left locking member 1625 hasa zero-degree locking feature 1630 and a 180 degree locking feature1635. In this exemplary embodiment, the zero degree locking feature 1630is in the form of a peripheral cutout of the left locking member 1625,and the 180-degree locking feature 1635 is in the form of an apertureinterior to the periphery of the left locking member 1625.

The right axel 1605 is slidably coupled to a complementary right lockingmember 1640, in this embodiment in the form of a housing (shown intransparent fashion). The right locking member 1640 is rotationalcoupled to the right axle 1605 via rotational locking system. Therotational locking system includes a transverse coupling member 1645that is rotationally coupled to the right drive axle 1605. Within theright locking member 1640 are opposing slots 1650 that are parallel to arotational axis about which the right 1605 and left 1610 drive axlesrotate. The transverse coupling member 1645 may slide within theopposing slots 1650. But the transverse coupling member 1645 and slots1650 provide rotational coupling between the two members 1645, 1650.

The right coupling member 1640 has a zero-degree coupling member 1655,which, in this embodiment, includes a projecting feature configured toengage the zero-degree coupling recess 1630 of the left locking member1625. In this embodiment, the zero-degree coupling member 1655 is in theform of a tab that, when engaged within the zero-degree coupling recess1630 provides rotational coupling at zero degrees phase difference. Theright coupling member 1640 also has 180-degree coupling member 1660configured to engage the 180-degree coupling feature 1635 of the leftlocking member 1625. In this embodiment, the 180-degree coupling member1660 is in the form of a spring loaded pin configured to engage theaperture of the left locking member 1625.

The right coupling member 1640 may be axially slid from a zero-degreephase position to a 180-degree phase position. When transitioning fromthe zero-degree phase position to the 180-degree phase position, theuser may control a transmission lever 1670 to provide a force directingthe slidable right locking member 1640 toward the left locking member.The force may be provided by a spring 1665, for example. And whentransitioning from the 180-degree phase position to the zero-degreephase position, the user may control operate the transmission lever 1670in a manner substantially inverse from the operation used to transitionfrom the zero-degree phase position to the 180-degree phase position.Such an inverse operation may provide a force directing the slideableright locking member 1640 away from the left locking member 1625, forexample.

In the depicted embodiment, a drive belt 1675 may provide power torotate the left drive axle 1610. When transitioning either from thezero-degree phase relation to the 180-degree phase relation or viceversa, rotating the left drive axle 1610 will result in only therotation of the left drive axle 1610 until the complementary lockingmembers 1625, 1640 become coupled in the intended phase manner. Whentransitioning from a walking position to a standing position, the weightof a user's body may facilitate a rapid transition to a zero-degreephase relation when both foot rests attain their minimal gravitationalenergy position (e.g. their lowest z-height).

FIGS. 17A-17B depict an exemplary stand-to-walk transmission system.FIG. 17A depicts a stand-to-walk transmission system 1700 in a standingmode. FIG. 17B depicts the stand-to-walk transmission system 1700 in awalking mode. The stand-to-walk transmission system 1700 includes acontrol lever 1705. The control lever 1705 is pivotably coupled to theframe at a pivot point 1710. The control lever 1705 is also coupled to alinkage system 1715 that controls the vertical throw of a transmissionconnecting rod 1720. The transmission connecting rod 1720 is connectedto the control lever 1725, which operates the slidable right lockingmember 1730. A zero-degree safety system 1735 operates to ensure thatthe transmission is in a zero-degree phase relationship whenever thepivotable seat assembly is lowered to a sitting position. Such azero-degree safety system may advantageously protect a user from injuryresulting from improper body kinetics during sitting transitions.

FIGS. 18A-18B depict an exemplary zero-degree safety system. FIG. 18Adepicts a zero-degree safety system 1800 when a pivotable seat assemblyis in a sitting position. FIG. 18B depicts the zero-degree safety systemwhen a pivotable seat assembly is in a walking position. In FIGS.17A-17B, a control arm 1740 may pivot in response to the position of thepivotable seat assembly. In both FIGS. 18A-B, a foot phase controlsystem 1800 includes a hand control mechanism 1805, a transmissionmodule 1810 and a zero-degree safety system 1815. The zero-degree safetysystem 1815 may ensure that a user's feet are in a side-by-sideconfiguration during sit-to-stand and/or stand-to-sit operations.Ensuring such a side-by-side feet configuration during such operationsmay advantageously prevent injury that may result from anatomicallyincorrect feet position during such standing or sitting operations.

The hand control mechanism 1805 depicted in FIGS. 18A-B include a manualcontrol lever 1820 that may be actuated by a user. The depicted manualcontrol lever 1820 may be toggled between a first position depicted inFIG. 18A and a second position depicted in FIG. 18B. The first position,depicted in FIG. 18A may force a transmission control rod 1825 towardthe transmission module 1810. When the transmission control rod 1825 isforced toward the transmission module 1810, the transmission module 1810may couple a right and a left foot drive gears in a zero-degree phaserelation. The second position, depicted in FIG. 18B may force atransmission control rod 1825 away from the transmission module 1810.When the transmission control rod 1825 is forced away from thetransmission module 1810, the transmission module 1810 may couple aright and a left foot drive gears in a 180-degree phase relation.

A biasing force may be used to bias the hand control mechanism 1805. Forexample, a spring may bias the transmission control rod 1825 in thedirection toward the transmission module 1810. When so biased, the handcontrol mechanism 1805 may have two stable positions, the depicted firstposition of FIG. 18A and the depicted second position of FIG. 18B.Positions that are intermediate to the first position and the secondposition may automatically return to either the first position or thesecond position by the biasing mechanism.

The depicted hand control mechanism 1805 has a four-bar linkage system1830 that four pivotable connections 1832, 1834, 1836, 1838. When afirst 1832 of the four pivotable connections 1832, 1834, 1836, 1838 isbelow center of a position between a second 1834 and a third 1836 of thefour pivotable connections 1832, 1824, 1826, 1838, the biasing mechanismmay return the first pivotable connection 1832 to the first position,depicted in FIG. 18A, absent user control of the manual control lever1820. When the first pivotable connection 1832 is above center of theposition between the second 1834 and the third 1836 pivotableconnections, the biasing mechanism may return the second pivotableconnection 1832 to the second position, depicted in FIG. 18B, absentuser control of the manual control lever 1820.

There may be a danger, however, that the user may forget to manuallyoperate the control lever 1820 to lock the user's feet in a side-by-sideconfiguration before the user actuates the pump release that allows theuser to sit. The zero-degree safety system 1815 may be configured toautomatically operate the control lever 1820 to the first position whenthe seat is being lowered to a sitting position. The zero-degree safetysystem 1815 may pull the first pivotable connection 1832 below center ofthe location between the position between the second 1834 and third 1836pivotable connections, when the seat assembly is lowered below apredetermined threshold.

As the seat assembly is lowered, a control bar 1840, which is coupled toboth a pivotable seat connecting member 1845 and a pivoting plate 1850,moves. When the control bar 1840 moves, the pivoting plate 1850 pivotsabout a pivot point 1855. As the pivoting plate 1850 pivots in acounter-clockwise direction, a connecting member 1860 pulls downwardlyon a connecting rod 1865. The downward moving connecting rod 1865 pullsthe first pivotable connection 1832 downward. When the first pivotableconnection 1832 is pulled below center of the second 1834 and third 1836pivotable connections, the biasing mechanism may complete the operationof placing the foot phase control system 1800 into the first position,depicted in FIG. 18A.

FIGS. 19A-19C depict an exemplary automated treadmill therapy system. InFIGS. 19A-19C an exemplary treadmill therapy system 1900 includes aframe 1902, a sit-to-stand system 1904, a natural-gait assisting system1906, a locomotion power drive system 1908, and a treadmill system 1910.In FIG. 19A the exemplary treadmill therapy system 1900 is depicted in asitting position. Treadmill therapy devices may be used, for example, toprovide therapy to users who have some leg function. For example, astroke victim may have use of one side of the victim's body. And so atherapy device that permits the stroke victim to walk on one side, whilesimultaneously assisting the other side may yield positive medicalbenefits. A philosophy of such a therapy device is to provide agraduated level of assistance to a person and only where needed.

In the depicted embodiment, the locomotion power drive system 1908includes an electric motor 1912. The electric motor 1912 may prove drivepower to one or both of the treadmill system 1910 and the natural-gaitsystem 1906. The treadmill system 1910 and the natural-gait assistingsystem 1906 may be powered in a coordinated fashion. For example therate that the treadmill runs may be substantially the same rate that thenatural gait system runs. The natural-gait assisting system 1906includes a lower leg engagement system 1914. The lower leg engagementsystem 1914 may include a stirrup 1916 to provide support to a user'sfoot. In some embodiments, the stirrup 1916 may be made of a flexiblematerial. For example, the stirrup 1916 may include a webbing material.A flexible stirrup 1916 may permit a user to engage a treadmill surfacewhen the natural-gait assisting system positions the user's foot inclose proximity to the treadmill surface. Synchronizing the treadmillsystem 1910 to the natural-gait assisting system 1906 may provideoptimum therapy to user's who have some limited motor function.

In FIG. 19B, the depicted treadmill therapy system 1900 has dissimilarconnecting members for left leg engagement system 1918 and a right legengagement system 1920. A right-side connecting member 1922 may rigidlyconnect the right leg engagement system 1920 to a right-sidenatural-gait control member. A left-side connecting member 1924 mayflexibly connect the left leg engagement system 1918 to a left-sidenatural-gait control member. The left-side connecting member 1924, maypresent a spring force to the user's left leg, for example. If the userdesires to move the left leg in somewhat dissimilar manner than themotion imparted by the natural-gait assisting system, the left-sideconnecting member 1924 may accommodate such dissimilar movements.

In some embodiments, the flexible connecting member 1924 may permitforward and/or backward lower leg movement (e.g. x-axis movement). Insome embodiments, the flexible connecting member 1924 may permitvertical lower leg movement (e.g. z-axis movement). In some embodimentsthe flexible connecting member 1924 may permit x-z rotational movements.In some embodiments, various combinations of such permitted movementsmay be together permitted. In an exemplary embodiment, only a legengagement system and its associated connecting member may be entirelyremoved so as to permit a user to use one side of the treadmillindependently while being assisted on the other side.

In various embodiments, a leg engagement system may include pressuresensors therein. Such pressure sensors may provide feedback for use inassessing a therapy session, for example. A pressure measurement may,for example, provide information useful in adjusting a spring constantor a gas pressure in a flexible connecting member 1924. Such changes mayeffect a change in the resistance offered by the flexible connectingmember 1924.

In some embodiments, the sit-to stand system 1904 may lift a user notjust to a standing position, but to a position just above such astanding position. After being lifted to such a position, the user maybe lowered to the treadmill in a manner that controls the amount of auser's weight that is subjected to the treadmill. The user may employ aseat-attached harness 1926 to secure the user's legs to a seat bottom1928, for example. The seat may have a deployable support member 1930for supporting the user when the seat bottom is otherwise orientedperpendicular to a ground surface (e.g. when in the standing position).The deployable support member 1930 may be pivotably connected to theseat bottom 1928. The deployable support member 1930 may be rotated toproject between a user's legs, thereby providing a support.

Various means of controllably lowering a user to the treadmill may beperformed. For example, the controlled lowering of a user to thetreadmill may be performed using a seat slide control system 1932. Theseat bottom 1928 may be slidably coupled to a seat support member 1934.The seat bottom 1928 may be ratcheted back before the user transitionsto a standing position. In some embodiments, the seat bottom 1928 may beratchet up as the user transitions to a standing position. In someembodiment, a hydraulic pump may provide power for seat-slide operation.In some embodiments and electric motor may provide power for seat-slideoperation. Controlling the amount of weight that a user's legs must bearmay advantageously minimize injury risk to user's who have poor bonedensity, for example.

FIGS. 20A-D depict an exemplary lift system for use with a natural-gaittherapy system. FIG. 20A, depicts the exemplary lift system 2000 in asitting configuration. In such a sitting configuration, a harness 2005is accessable to a user who is seated in a chair 2010. The user maysecure the harness 2005 to the user's body. The user may then actuate apivoting mechanism 2015 to lift the user to a standing configuration,such as that depicted in FIG. 20B. The depicted exemplary lift system2000 includes a linear lifting mechanism 2020 that can be used to raiseor lower the user to a desired altitude above a treadmill 2025, forexample. A lift control system may coordinate the operation of both thelinear mechanism 2020 and the pivoting mechanism 2015 to raise the userfrom a sitting position to a standing position in an atomically correctfashion. In some embodiments, a lifting trajectory may be customized foreach user of the natural-gait therapy system.

In some embodiments, after the user has been lifted to a standingposition, the user may adjust the linear mechanism 2020 to permit moreor less body weight incident upon the treadmill surface. For example, auser who may have been injured may desire to be substantially suspendedhigh above the treadmill. As the user heels over time, the user mayadjust the linear mechanism 2020 lower and lower. A lower position maypermit the user to bear more of the user's weight as the user isheeling. Eventually, as the user becomes strong, the user may positionadjust the linear mechanism 2020 so low that the user bears virtuallyall of the user's weight. The harness may simply be present, in such acase, as a safety device should the user fall during therapy.

FIG. 20D depicts a closeup perspective view of the exemplary lift system2000. The linear mechanism 2020 has been made semi-transparent so thatinner rolling guides 2025 are visible. In the depicted embodiment, thepivoting mechanism 2015 can be actuated via a hydraulic pump 2030. Thelinear mechanism 2020 too is actuatable by a hydraulic pump 2035. Eachof these hydraulic pumps 2030, 2035 may be controlled by toggle switches2040 accessable to a user.

FIG. 21A depicts a schematic diagram of an exemplary multi-modal therapyplatform control system. In the figure, an exemplary multi-modal therapydevice 2100 and a therapy control system 2105 are depicted. The depictedmulti-modal therapy device 2100 is automated so as to facilitate therapyfor a user who may have severely compromised physical function, forexample. The automated functions of the multi-modal therapy device 2100includes a seat lift motor 2110, a solenoid actuator 2115 for a footphase transmission module, and a natural-gait locomotion motor 2120.Each of these automated functions may be coordinated by a powercontroller 2125 of the therapy control system 2105.

The multi-modal therapy device 2100 includes pressure sensors 2130 formonitoring a user's engagement of the various engagement surfaces (e.g.seat bottom, seat back, knee rests, foot rests, etc.). A pressuremonitoring system 2135 may receive signals from the pressure sensors2130, each signal may be indicative of a pressure at an engagementsurface. The received signals may be used in various ways. For example,the pressure controller may record these pressure indicative signals foruse in post therapy analysis. If a received signal indicates anoverpressure condition, the pressure controller may send a signal to thepower controller, the sent signal indicating that the power controllershould terminate operation, for example.

Functional Electrical Stimulation (FES) and/or bio-feedback may beperformed using the depicted multi-modal therapy device 2100. An FEScontroller and/or bio feedback system 2140 may receive signals from aphase detector 2145 indicative of a user's leg positions within anatural-gait cycle. The FES controller and/or bio feedback system 2140may send signals to muscle stimulating electrodes 2150 for stimulatingvarious muscles in response to the detected positions of a user's legs.In this way, stimulation of a user's muscles may be coordinated withposition corresponding to one that these muscles would be activated ifthe user were locomoting the gait under the user's own power. Biofeedback sensors may sense electrical activity associated with thestimulated muscles. The sensed electrical activity may be sent to theFES controller and/or bio feedback system 2140. In some embodiments, theelctrodes 2150 may be used for both electrical stimulation and forsensing electrical activity of a particular muscle or muscle group1. Insome embodiments, an electrical sensor distinct from an associatedstimulation electrode may be used to sense electrical activityassociated with a muscle or muscle group.

Neural stimulation (NS) may be performed on a user's spinal region usingthe depicted multi-modal therapy device 2100. An NS controller 2155 mayinterface with various components located proximate a seatback assembly2160. The NS controller may control operation of an electric neuralstimulator 2165 which can be positioned at an appropriate locationrelative to a user's spine. For example the neural stimulator 2165 maybe positioned near an injury location of a user's spine. A positionmotor 2170 may be controlled by the NS controller 2155, for example. TheNS controller 2155 may position the neural stimulator 2165 in a staticfashion, for example. The NS controller 2155 may dynamically oscillatethe position of the neural stimulator 2165 about a spinal location, forexample. The NS controller 2155 may receive imagery and/or otherdiagnostic signals from a camera 2170 and/or other sensors, in someembodiments. The NS controller 2155 may control an excitation of a laserstimulator 2175. In some embodiments the laser stimulator 2175 may bepositionable by the NS controller 2155.

FIG. 21B depicts an exemplary multi-modal gait-based therapy platform.In the FIG. 21B embodiment, a multi-modal gait-based therapy platform2100 includes a synchronized muscle stimulation system, a nervestimulation system, a powered natural-gait system, and a pressuremonitoring system. The synchronized muscle stimulation system mayelectrically cause muscle contractions of various muscles at appropriatephases of a natural-gait cycle. The synchronized muscle stimulationsystem may include a phase detection system 2145, a muscle electrodesystem, and an FES controller and/or bio feedback system 2135. The phasedetection system 2145 may include a drive axle angle detector. Such aphase detection system 2145 may include a shaft encoder. Shaft encodersmay be optical, for example. In some embodiments a shaft encoder may bemechanical. In an exemplary embodiment the phase detection system 2145may include a 360-degree hall sensor.

The muscle electrode system may include a muscle stimulating electrodes2150. The muscle stimulating electrodes 2150 may be coupled to a kneepad assembly for example. The muscle stimulating electrodes 2150 may bein the form of a cuff containing an exposed electrode. The user maysimply affix the cuff to the body part aligning to the cuff. In someembodiments, a Velcro strap may belt the cuff to a leg, for example. Inan exemplary embodiment, the cuff may be secured using a webbing andclasp, for example.

In some embodiments, an electrical stimulator cuff may be configured toself-align to muscles in the upper leg. In an exemplary embodiment, anelectrical stimulator cuff may be configured to self-align to muscles inthe lower leg. In the depicted embodiment, both such electricalstimulator cuffs are present, and upper leg stimulator 2122 and a lowerleg stimulator 2124. Control signals for an electrical stimulator may berun within frame members of the multi-modal gait-based therapy platform2100 so as not to present hazards (e.g. wires caught on clothing) to auser.

The FES controller 2140 may receive signals indicative of the phase fromthe phase detection system 2145. The FES controller 2140 may calculate aphase based on the received signal indicative of the phase. The FEScontroller 2140 may compare the calculated phase to a predeterminedsignal initiation phase associated with a specific muscle or musclegroup. The FES controller 2140 may compare the calculated phase to apredetermined signal termination phase associated with the specificmuscle or muscle group. If the calculated phase is greater than thesignal initiating phase and less than the signal termination phase, theFES controller 2140 may send a predetermined stimulation signal to anelectrode associated configured to couple to the specific muscle ormuscle group.

A bio-feedback system 2140 may be used in conjunction with the FEScontroller and/or independently. The bio-feedback system may senseelectrical activity associated with a muscle or muscle group. Anelectrical activity sensor may be included in the electrical stimulatorcuffs 2150. In some embodiments, the stimulator electrode may be used asan electrical activity sensor. In some embodiments, an electricalactivity sensor may be distinct from a stimulator electrode. Theelectrical activity sensor may send a signal indicative of sensedelectrical activity to a bio-feedback system monitor. In someembodiments the sensed electrical activity signal may be send to adisplay device for presentation to the user. In some embodiments theelectrical activity signal may be logged for later analysis by atherapist or care giver.

Various methods of spinal therapy may be coordinated with themulti-modal gait-based therapy platform 2100. A spinal therapy system2102 may be coupled to a seat back 2104 of the multi-modal gait-basetherapy platform 2100. The spinal therapy system 2102 may include one ormore distinct spinal therapy systems. By way of example and notlimitation, an exemplary spinal therapy system 2102 may include a laserstimulation system, an electrical nerve stimulation system, anelectrical sensing system, and/or one or more monitoring device (e.g. acamera, an ultrasonic sensor, etc.). The spinal therapy system 2102 maybe positionable along a user's spine. In the depicted embodiment, theseat back 2014 has a recess 2106 between a right side 2108 and a leftside 2112. The spinal therapy system 2102 may be configured to bepositioned vertically within the recess 2106. In some embodiments, aposition control system may statically and/or dynamically position thespinal therapy system 2102 within the vertical recess 2106.

FIGS. 22A-B depict close-up views of an exemplary spinal therapy system.In the FIGS. 22A-B depiction, an exemplary spinal therapy system 2200includes a positionable carrier 2205 and a positioning system 2210. Thepositional carrier 2205 includes two rolling stimulating electrodes2215, an electrical activity sensor 2220, a laser 2225, and a visiblelight camera 2230. The positioning system 2210 includes a motor 2235 anda screw drive 2240 coupled via a belt 2245. The positioning system 2210may statically locate the positionable carrier 2205 at a fixed positionalong the screw drive 2240, for example. The positioning system 2210 mayoscillated the positionable carrier 2205 up and down along the screwdrive 2240 in some modes, for example. When the positioning system 2210is operating in a dynamic mode, the rolling stimulating electrodes maymaintain electrical connection with a user's back. In some embodiments,one of the rolling stimulating electrodes may be located on one side ofa user's spine and the other of the rolling stimulating electrodes maybe located on the other side of the user's spine.

-   -   The positionable carrier may have a biasing system 2250 that        keeps the therapy subsystems 2215, 2220, 2225 in contact with a        user's back. In some embodiments, the biasing system may        independently bias each of the subsystems 2215, 2220, 2225, so        as to maintain contact with a user's back. In some embodiments,        a single biasing mechanism may be used to provide a biasing        force to the positionable carrier 2210, for example. In some        embodiments, the spinal therapy system 2200 may communicate with        a remote communications system. For example, the signal        information detected by the various analysis devices may be        transmitted to a remotely located therapist. The remotely        located therapist may then analyze the data and decide to modify        the position of a laser therapy device, for example. The        remotely located therapist may then send control signals to the        nerve stimulation system 2004 corresponding to the laser        position. The spinal therapy system 2200 may then provide        corresponding control signals to the laser positioning device.

In some embodiments, an automated leg connecting member may adaptivelyprovide movement correction to that movement provided by thenatural-gait assisting system. For example, a user may have good use ofone side of the body but poor use of the other side. The good-use sidemay be connected to a flexible connecting member that has sensors tosense the movement difference between that provided by the natural-gaittherapy system and the user's actual movement. The automated legconnecting member may then provide the identical corrections at theappropriate phase of the natural-gait of the poor-use side. In this way,the poor-use side will be stimulated to operate in a symmetric manner asthe good-use side.

Other features are depicted in the FIG. 21B embodiment. For example, thedepicted multi-modal gait-based therapy platform 2100 includes hipsupport pads 2026. The hip support pads 2026 may be rotatable coupled tothe seat bottom 2028 so as to be able to rotate out of a user's way whenentering and exiting the multi-modal gait-based therapy platform 2100.Similarly, lateral support structures 2132 may be rotatably coupled tothe backrest 2104. Such lateral support structures 2132 may providesupport at the sides of a user's torso, for example. A quad grip drivehandles 2134 are shown coupled to crank members 2136 of a power drivesystem. In some embodiments that have a motor drive, such as thedepicted multi-modal gait-based therapy platform 2100, a motordisconnect may permit a user to select between providing power manuallyor electrically, for example.

Various users may configure a multi-modal gait-based therapy platform2100 in various ways. Some users may require more automation, forexample, than other users. For users who require more automation, themulti-modal gait-based therapy platform 2100 may be configured with apower sequencer. The power sequencer may be configured to provide powerto the sit-to-stand system in response to an input signal generated by auser interface. The power sequencer may then actuate the stand-to-walktransmission in response to another input signal generated by a userinterface. The power sequencer may then actuate a motor that drives thenatural-gait locomotion system, for example. The power sequencer maythen actuate terminate the natural-gait locomotion system in response toan input signal generated by a user interface. The power sequencer maythen actuate the stand-to-walk transmission to return the user's feet toa side-by-side condition. The power sequencer may then transition theuser from a standing position to a sitting position.

FIG. 23 depicts a flow chart of an exemplary method of providingcoordinated muscle stimulation in response to a natural-gait position ofa user's body. In FIG. 23, an exemplary method 2300 of performingelectric stimulation of a user's muscles is depicted from theperspective of the FES controller 2140 of FIG. 21A. The method 2200begins with the FES controller 2140 receiving, from a phase detector2145, a signal, p, indicative of a phase 2305. Then the FES controller2140 initializes an index, n, indicative of one of a plurality ofelectric muscle stimulators, which may be associated with a particularmuscle and/or muscle group 2310. Then the index, n, is compared with amaximum index, n_(max) 2315. If the index, n, is less than the maximumindex n_(max), then the FES controller 2140 retrieves a stimulationsignal, stim(n, p) 2320. The stimulation signal, stim(n, p), may relatean electrical stimulation strength with a phase for a particular muscleand/or muscle group associated with the index, n, for example. Then theFES controller send the retrieved stimulation signal, stim(n, p), to anelectrode configured to contact a user's body in such a way to provide asignal to the associated muscle and/or muscle group 2325. Then the FEScontroller increments the index, n 2330 and returns to step 2315. If, atstep 2315, the index, n, is greater than the maximum index, n_(max),then the method returns to step 2305 and again receives a phase signal,p.

FIGS. 24A-B depict an exemplary foot rest for coordinated operation witha tread mill. In FIG. 24A, an exemplary foot-rest assembly 2400 includesa forefoot platform 2405 pivotably coupled to a heal platform 2410. Theforefoot platform 2405 is slidably coupled to an exemplary verticalpositioner 2415. A spring member 2420 provides a bias which encouragesthe forefoot platform 2405 in the direction of a preferred positionwhere the forefoot platform 2405 is coupled to a bottom end of thevertical positioner 2415. When the forefoot platform 2405 engages a hardsurface, such as a treadmill surface, for example, the forefoot platform2405 may move against the spring bias toward a top end of the verticalpositioner 2415. In some embodiments, a toe-position control system mayengage the vertical positioner 2415 at a coupling point 2425.

In some embodiments, a forefoot strike detection module may detect whenthe forefoot platform engages a hard surface. For example, a microswitch may be closed when the forefoot platform moves against the springbias. The forefoot strike detection module may send a signal to the FEScontroller and/or bio-feedback detection system. The FES controller maysend a signal in response to the received forefoot strike detectionsignal. The FES response signal may be an electrical stimulation signalfor a muscle or muscle groups that are associated with a forefoot pushoff movement during a natural-gait cycle.

FIG. 24B depicts an exemplary cycle of a natural gait 2330. The cycle ofthe natural gait 2430 may represent the position of an exemplarytoe-position control point, for example. The dotted line 2435 mayrepresent a top surface of a tread mill. A bottom portion 2440 of thecycle of the natural gait 2430 is below the top surface of the treadmill 2435. During the phases in which the toe-position control point isbelow the top surface of the tread mill, a vertical positioner maypermit a foot rest to deviate from the position defined by the cycle ofthe natural gait 2430 and follow the top surface of the tread mill 2435.The resulting cycle 2445 may be that depicted in the figure. Such aresulting natural gait cycle may permit a user to engage the top surfaceof a treadmill when using a natural gait therapy system.

FIG. 25 depicts a closeup perspective view of exemplary FES stimulationand bio-feedback cuffs. In the FIG. 25 depiction, an upper leg FESstimulation and bio feedback cuff 2500 is tethered to a knee engagementsystem 2505 via a flexible webbing 2510. Electrical wires connectstimulation electrodes 2515 with an FES/biofeedback control module. Theelectrical wires may run within various structural members of anatural-gait therapy device. The electrical wires may be embedded withinthe flexible webbing 2510, for example. The cuff 2500 may be an annularelastic band that maintains a tight connection between the stimulationelectrodes 2515 and a user's legs, for example. The cuff may betightened with a belt or a securing device, in some embodiments. In theexemplary depiction, a lower leg FES stimulation and bio feedback cuff2520 is also tethered to the knee engagement system 2505. In someembodiments, bio feedback electrodes may be coupled to the cuffs 2500,2520. In an exemplary embodiment the stimulation electrodes 2515 mayalso provide biofeedback sensing of electrical activity in the usersbody.

FIG. 26 depicts an exemplary natural-gait therapy system that isautomated. In the FIG. 26 depiction, an exemplary phase detector 2600 iscoupled to a main drive shaft. The phase detector 2600 may be configuredto detect the angular phase of the main drive shaft and generate asignal corresponding to the detected angular phase. In the FIG. 26depiction, the natural-gait therapy system 2605 includes a natural-gaitlocomotion motor 2610 that may provide locomoting power to the maindrive shaft via belt 2615. The natural-gait therapy system 2605 includesan exemplary automatic transmission change module 2620 and a poweredseat-lift motor 2625. Such an exemplary powered natural-gait therapysystem may provide therapy to users who may require powered operation,for example.

In some embodiments, an upper-leg control member may be pivotablysuspended from a support member. In some embodiments, the support membermay be a fixed support member configured to provide pivotable suspensionof the upper-leg control member on a pivot axis that intersects a user'ship. In some embodiments, the support member may be cyclically driven soas to simulate the motion of a human hip location when walking, forexample. In some embodiments, left and right support members may be movein phase with each other. In some embodiments, left and right supportmembers may move 180 degrees out of phase with each other, when in awalking mode.

Some aspects of embodiments may be implemented as a computer system. Forexample, various implementations may include digital and/or analogcircuitry, computer hardware, other sensors (e.g. temperature sensors),firmware, software, or combinations thereof. Apparatus elements can beimplemented in a computer program product tangibly embodied in aninformation carrier, e.g., in a machine-readable storage device, forexecution by a programmable processor; and methods can be performed by aprogrammable processor executing a program of instructions to performfunctions of various embodiments by operating on input data andgenerating an output. Some embodiments can be implemented advantageouslyin one or more computer programs that are executable on a programmablesystem including at least one programmable processor coupled to receivedata and instructions from, and to transmit data and instructions to, adata storage system, at least one input device, and/or at least oneoutput device. A computer program is a set of instructions that can beused, directly or indirectly, in a computer to perform a certainactivity or bring about a certain result. A computer program can bewritten in any form of programming language, including compiled orinterpreted languages, and it can be deployed in any form, including asa stand-alone program or as a module, component, subroutine, or otherunit suitable for use in a computing environment.

Suitable processors for the execution of a program of instructionsinclude, by way of example and not limitation, both general and specialpurpose microprocessors, which may include a single processor or one ofmultiple processors of any kind of computer. Generally, a processor willreceive instructions and data from a read-only memory or a random accessmemory or both. The essential elements of a computer are a processor forexecuting instructions and one or more memories for storing instructionsand data. Storage devices suitable for tangibly embodying computerprogram instructions and data include all forms of non-volatile memory,including, by way of example, semiconductor memory devices, such asEPROM, EEPROM, and flash memory devices; magnetic disks, such asinternal hard disks and removable disks; magneto-optical disks; and,CD-ROM and DVD-ROM disks. The processor and the memory can besupplemented by, or incorporated in, ASICs (application-specificintegrated circuits). In some embodiments, the processor and the membercan be supplemented by, or incorporated in hardware programmabledevices, such as FPGAs, for example.

In some implementations, each system may be programmed with the same orsimilar information and/or initialized with substantially identicalinformation stored in volatile and/or non-volatile memory. For example,one data interface may be configured to perform auto configuration, autodownload, and/or auto update functions when coupled to an appropriatehost device, such as a desktop computer or a server.

In some implementations, one or more user-interface features may becustom configured to perform specific functions. An exemplary embodimentmay be implemented in a computer system that includes a graphical userinterface and/or an Internet browser. To provide for interaction with auser, some implementations may be implemented on a computer having adisplay device, such as an LCD (liquid crystal display) monitor fordisplaying information to the user, a keyboard, and a pointing device,such as a mouse or a trackball by which the user can provide input tothe computer. For example, wearable devices, such as Google Glasses orother technologies may facilitate input and/or output operations betweena user and a system.

In various implementations, the system may communicate using suitablecommunication methods, equipment, and techniques. For example, thesystem may communicate with compatible devices (e.g., devices capable oftransferring data to and/or from the system) using point-to-pointcommunication in which a message is transported directly from the sourceto the receiver over a dedicated physical link (e.g., fiber optic link,point-to-point wiring, daisy-chain). The components of the system mayexchange information by any form or medium of analog or digital datacommunication, including packet-based messages on a communicationnetwork. Examples of communication networks include, e.g., a LAN (localarea network), a WAN (wide area network), MAN (metropolitan areanetwork), wireless and/or optical networks, and the computers andnetworks forming the Internet. Other implementations may transportmessages by broadcasting to all or substantially all devices that arecoupled together by a communication network, for example, by usingomni-directional radio frequency (RF) signals. Still otherimplementations may transport messages characterized by highdirectivity, such as RF signals transmitted using directional (i.e.,narrow beam) antennas or infrared signals that may optionally be usedwith focusing optics. Still other implementations are possible usingappropriate interfaces and protocols such as, by way of example and notintended to be limiting, USB 2.0, Firewire, ATA/IDE, RS-232, RS-422,RS-485, 802.11 a/b/g/n, Wi-Fi, Ethernet, IrDA, FDDI (fiber distributeddata interface), token-ring networks, or multiplexing techniques basedon frequency, time, or code division. Some implementations mayoptionally incorporate features such as error checking and correction(ECC) for data integrity, or security measures, such as encryption(e.g., WEP) and password protection.

A number of implementations have been described. Nevertheless, it willbe understood that various modification may be made. For example,advantageous results may be achieved if the steps of the disclosedtechniques were performed in a different sequence, or if components ofthe disclosed systems were combined in a different manner, or if thecomponents were supplemented with other components. Accordingly, otherimplementations are contemplated.

1. A natural-gait therapy device comprising: a support member; aknee-position control system comprising: an upper-leg control memberpivotably suspended by the support member, the upper-leg control memberconfigured to move parallel to an upper leg of a user throughout a cycleof a natural gait; a lower-leg control member pivotably suspended by theupper-leg control member, the lower-leg control member configured tomove parallel to a lower leg of a user throughout the cycle of thenatural gait; and, a knee-engagement pad operatively coupled to at leastone of the upper-leg control member or the lower-leg control member, theknee-engagement pad configured to maintain substantially staticengagement with a user's knee throughout the cycle of the natural gait;a natural-gait user support module pivotably suspended by the lower-legcontrol member, the natural-gait user support module configured tosupport a user throughout the cycle of the natural gait; and, astand-to-walk transmission system having a standing mode and a walkingmode.
 2. The natural-gait therapy device of claim 1, wherein thenatural-gait user support module is configured to move a user's footalong a elliptical natural-gait path.
 3. The natural-gait therapy deviceof claim 1, wherein the natural-gait user support module includes aforefoot rest having a forefoot engagement surface configured tomaintain substantially static engagement with a user's forefootthroughout the cycle of a natural gait.
 4. The natural-gait therapydevice of claim 1, wherein the natural-gait user support module includesa heel rest having a heel-engagement surface configured to maintainsubstantially static engagement of a user's heel throughout the cycle ofthe natural gait.
 5. The natural-gait therapy device of claim 1, whereinthe natural-gait user support module has a forefoot-engagement surfaceand a heel-engagement surface, wherein an angle between a normal vectorof the forefoot-engagement surface and a normal vector of a floorsurface forms a forefoot angle, and wherein an angle between a normalvector of the heel-engagement surface and the normal vector to the floorsurface forms a heel angle, wherein the heel angle is greater than theforefoot angle during a first portion of the cycle of the natural gait,and the heel angle is substantially equal to the forefoot angle during asecond portion of the cycle of the natural gait.
 6. The natural-gaittherapy device of claim 1, further comprising a powered natural-gaitlocomotion system operatively coupled to drive the natural gait therapydevice through the cycle of the natural gait in a periodically repeatingfashion, each cycle comprising 360 degrees per period,
 7. Thenatural-gait therapy device of claim 6, wherein the powered natural-gaitlocomotion system comprises a drive power subsystem and a natural-gaitcontrol mechanism.
 8. The natural-gait therapy device of claim 7,wherein the natural-gait control mechanism comprises a toe-positioncontrol subsystem configured to position a toe portion of thenatural-gait user support module at a predetermined location for eachphase of the cycle of the natural gait in response to the drive powersubsystem.
 9. The natural-gait therapy device of claim 8, wherein thepowered natural-gait control mechanism comprises a forefoot-anglecontrol system configured to coordinate an angle of a forefoot portionof the natural-gait user support module at each phase of the cycle ofthe natural gait in response to the position of the toe portion of thenatural-gait user support module.
 10. The natural-gait therapy device ofclaim 9, wherein the knee-position control system is configured tocoordinate a positioning of the knee-engagement member at each phase ofthe natural-gait cycle in response to a coordinated movement of thetoe-position control system and the forefoot-angle control system. 11.The natural-gait therapy device of claim 10, wherein the powerednatural-gait control mechanism comprises a heel-lift control systemconfigured to coordinate a lift of a heel portion of the natural-gaituser support module at each phase of the cycle of the natural gait inresponse to a coordinated movement of the toe-position control system,the forefoot-angle control system, and the knee-position control system.12. The natural-gait therapy device of claim 1, wherein a foot rest isadjustably disposed on the natural-gait user support module tosubstantially maintain alignment of a user's knee and an axis of a pivotpoint at which the lower-leg control member is pivotably suspended bythe upper-leg control member.
 13. The natural-gait therapy device ofclaim 7, wherein the drive power subsystem is a hand powered system. 14.The natural-gait therapy device of claim 7, wherein the drive powersubsystem is a motor powered system.
 15. The natural-gait therapy deviceof claim 1, wherein the knee-position control system is a leftknee-position control system and the natural-gait user support module isa left natural-gait user support module, and the natural-gait therapydevice further comprises a right knee-position control system and aright natural-gait user support module.
 16. The natural-gait therapydevice of claim 15, wherein, when in the standing mode, the leftnatural-gait user support module and the right natural-gait user supportmodule are operatively coupled in the same phase of the cycle of thenatural gait, and wherein, when in the walking mode, the leftnatural-gait user support module and the right natural-gait user supportmodule are operatively coupled at 180 degrees phase difference in thecycle of the natural gait.
 17. The natural-gait therapy device of claim15, further comprising a sit-to-stand system comprising: a base member;a seat bottom; and, a connecting member configured to connect the seatbottom to the base member, the connecting member having three segmentssubstantially-coplanar with a vertical plane oriented to bisect a user'sbody when seated on the seat bottom and with each foot engaging arespective one of the foot-engagement members, thesubstantially-coplanar segments being: (i) a base-connecting segmentpivotably coupled at a first end to the base member and extendingsubstantially downward from the first end to a first bend; (ii) alongitudinal segment connected to the base-connecting segment at thefirst bend and extending longitudinally to a second bend; and, (iii) aseat-connecting segment connected to the longitudinal segment at thesecond bend and extending upward in a substantially vertical directionto a second end which couples to the seat bottom.
 18. The natural-gaittherapy device of claim 17, wherein the connecting member is pivotableabout a pivot axis that intercepts a user's knees when engaged with theknee pads.
 19. The natural-gait therapy device of claim 17, wherein,when a user sits on the seat bottom with the user's knees engaging theknee engagement members and the user's feet engaging the natural-gaituser support modules, the user can be raised from a sitting position toa standing position in response to the seat bottom being pivoted aboutthe pivot axis from a first position to a second position.
 20. Thenatural-gait therapy device of claim 17, wherein a user's seat, feet andknees remain in substantially static contact with the seat bottom,natural-gait user support modules and knee-engagement members,respectively, in response to the seat bottom being pivoted about thepivot axis from the second position to the first position.
 21. Thenatural-gait therapy device of claim 17, further comprising an elevationmodule connected between the base member and the seat-support member,the elevation module configured to provide a force to pivot the seatbottom from the first position to the second position.
 22. The apparatusof claim 17, wherein, when in the first position, a normal vector to auser engagement surface of the seat bottom is substantiallyperpendicular to a ground surface.
 23. The apparatus of claim 17,wherein, when in the second position, a normal vector to a userengagement surface of the seat bottom is substantially parallel to aground surface.
 24. The apparatus of claim 17, wherein, when in thefirst position, a top surface of the longitudinal segment has anelevation that is less than three inches above an elevation of afoot-engagement surface of each of the natural-gait user supportmodules.
 25. The apparatus of claim 17, further comprising a seat backpivotably coupled to the seat bottom.
 26. The apparatus of claim 25,further comprising a seat-back attitude control system thatsubstantially maintains a seat-back attitude of the seat back, themaintained seat back attitude defined by a normal vector of a userengagement surface that is substantially parallel with a level groundsurface both when the seat bottom is in the first position and when theseat bottom is in the second position.
 27. The apparatus of claim 25,wherein the seat-back attitude control system includes linkage that runsthrough an interior cavity of the connecting member.
 28. The apparatusof claim 1, further comprising a Functional Electrical Stimulation (FES)system comprising: A phase detector configured to generate a phasesignal representative of the phase of the cycle of the natural gait; Amuscle stimulus signal that generates an electrical signal configured tostimulate a muscle or a muscle group in during a portion of the cycle ofthe natural gait; and An electrode configured to electrically couple toand deliver the generated muscle stimulus signal to a muscle or musclegroup of a user.
 29. The apparatus of claim 25, further comprising anerve therapy system slidably coupled to the seat back, the nervetherapy system having a laser that can be positioned along a portion ofthe user's spinal cord and configured to provide laser light therapy tothe user's spinal cord at the position.
 30. The apparatus of claim 2,further comprising a treadmill, wherein the treadmill is coordinatedwith the cyclic natural-gait path of the natural-gait user supportmodule.